Healthcare Provider Details

I. General information

NPI: 1053447334
Provider Name (Legal Business Name): KUKUI PLAZA DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S BERETANIA ST STE C201
HONOLULU HI
96813-2222
US

IV. Provider business mailing address

50 S BERETANIA ST STE C201
HONOLULU HI
96813-2222
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-4026
  • Fax:
Mailing address:
  • Phone: 808-536-4026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number871
License Number StateHI

VIII. Authorized Official

Name: MELVIN M.H. CHOY
Title or Position: PARTNER
Credential: D.D.S.
Phone: 808-536-4026