Healthcare Provider Details

I. General information

NPI: 1255186599
Provider Name (Legal Business Name): JAIME KIKA MASUNAGA DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST STE 101
HONOLULU HI
96814-1702
US

IV. Provider business mailing address

1010 S KING ST STE 101
HONOLULU HI
96814-1702
US

V. Phone/Fax

Practice location:
  • Phone: 808-597-1553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDT-3124
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: