Healthcare Provider Details

I. General information

NPI: 1225150758
Provider Name (Legal Business Name): KEVIN MIZOGUCHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 S KING ST
HONOLULU HI
96826-2222
US

IV. Provider business mailing address

2104 S KING ST
HONOLULU HI
96826-2222
US

V. Phone/Fax

Practice location:
  • Phone: 808-949-6608
  • Fax: 808-946-4555
Mailing address:
  • Phone: 808-949-6608
  • Fax: 808-946-4555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1450
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: