Healthcare Provider Details

I. General information

NPI: 1821075292
Provider Name (Legal Business Name): LUKE YOSHIHIDE TERUYA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981005 MOANALUA ROAD SUITE 847
AIEA HI
96701-4726
US

IV. Provider business mailing address

981005 MOANALUA ROAD SUITE 847
AIEA HI
96701-4726
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7933
  • Fax: 808-484-2351
Mailing address:
  • Phone: 808-487-7933
  • Fax: 808-484-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number61405
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: