Healthcare Provider Details

I. General information

NPI: 1144921750
Provider Name (Legal Business Name): KRISHNA GORADIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST STE 304
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

848 S BERETANIA ST STE 304
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-5071
  • Fax: 808-536-1424
Mailing address:
  • Phone: 808-531-5071
  • Fax: 808-536-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberR919
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-3087
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: