Healthcare Provider Details

I. General information

NPI: 1326322272
Provider Name (Legal Business Name): IVAN CHUAH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2011
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4473 PAHEE ST STE K
LIHUE HI
96766-2037
US

IV. Provider business mailing address

PO BOX 30869
ANAHOLA HI
96703-0869
US

V. Phone/Fax

Practice location:
  • Phone: 808-821-8898
  • Fax:
Mailing address:
  • Phone: 808-635-8668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2458
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: