Healthcare Provider Details

I. General information

NPI: 1740487768
Provider Name (Legal Business Name): ISAO MASUNAGA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 S KING ST SUITE 401
HONOLULU HI
96814-1701
US

IV. Provider business mailing address

1010 S KING ST SUITE 401
HONOLULU HI
96814-1701
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-6667
  • Fax: 808-591-1341
Mailing address:
  • Phone: 808-591-6667
  • Fax: 808-591-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number477
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: