Healthcare Provider Details

I. General information

NPI: 1588661847
Provider Name (Legal Business Name): RUSSELL HIROSHI MASUNAGA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2153 N KING ST STE 322
HONOLULU HI
96819-4559
US

IV. Provider business mailing address

2153 N KING ST STE 322
HONOLULU HI
96819-4559
US

V. Phone/Fax

Practice location:
  • Phone: 808-848-8880
  • Fax: 808-848-8814
Mailing address:
  • Phone: 808-848-8880
  • Fax: 808-848-8814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-1711
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: