Healthcare Provider Details

I. General information

NPI: 1386967792
Provider Name (Legal Business Name): MIRIAM M AMJADI DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 706
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD STE 706
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-946-0944
  • Fax: 808-949-1522
Mailing address:
  • Phone: 808-946-0944
  • Fax: 808-949-1522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number199901
License Number StateHI

VIII. Authorized Official

Name: DR. MIRIAM M AMJADI
Title or Position: DENTIST
Credential: DMD
Phone: 808-946-0944