Healthcare Provider Details

I. General information

NPI: 1275740649
Provider Name (Legal Business Name): JONATHAN OKABE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 ALA HINALO PL
HONOLULU HI
96818-2225
US

IV. Provider business mailing address

3425 ALA HINALO PL
HONOLULU HI
96818-2225
US

V. Phone/Fax

Practice location:
  • Phone: 808-833-1704
  • Fax:
Mailing address:
  • Phone: 808-833-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number998
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: