Healthcare Provider Details

I. General information

NPI: 1306972476
Provider Name (Legal Business Name): M. K. DENTAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1773 S KING ST SUITE 201
HONOLULU HI
96826-2183
US

IV. Provider business mailing address

1773 S KING ST SUITE 201
HONOLULU HI
96826-2183
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-1464
  • Fax:
Mailing address:
  • Phone: 808-941-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number333
License Number StateHI

VIII. Authorized Official

Name: MANUEL C. W. KAU
Title or Position: MEMBER-MANAGER
Credential: D.D.S.
Phone: 808-941-1464