Healthcare Provider Details

I. General information

NPI: 1912423401
Provider Name (Legal Business Name): MARK KUIOKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2714
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: