Healthcare Provider Details

I. General information

NPI: 1801953542
Provider Name (Legal Business Name): JOCHEN MADEISKY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-3872 AKONI PULE HWY.
KAPAAU HI
96755
US

IV. Provider business mailing address

PO BOX 428
KAPAAU HI
96755-0428
US

V. Phone/Fax

Practice location:
  • Phone: 808-889-6277
  • Fax: 808-889-0201
Mailing address:
  • Phone: 808-889-6277
  • Fax: 808-889-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD1051
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: