Healthcare Provider Details

I. General information

NPI: 1649405937
Provider Name (Legal Business Name): MICHAEL G. CHING, D.D.S., M.S., & SUSAN N. MIZUNO, D.D.S., M.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 05/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 YOUNG ST STE. 216
HONOLULU HI
96814-1609
US

IV. Provider business mailing address

1060 YOUNG ST STE. 216
HONOLULU HI
96814-1609
US

V. Phone/Fax

Practice location:
  • Phone: 808-525-7161
  • Fax: 808-525-7127
Mailing address:
  • Phone: 808-525-7161
  • Fax: 808-525-7127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1814
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1908
License Number StateHI

VIII. Authorized Official

Name: MRS. CASSIE ANN ITO-ALMAREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 808-525-7167