Healthcare Provider Details

I. General information

NPI: 1689123200
Provider Name (Legal Business Name): KUHIO PEDIATRIC DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3-3359 KUHIO HWY
LIHUE HI
96766-1061
US

IV. Provider business mailing address

3-3359 KUHIO HWY
LIHUE HI
96766-1031
US

V. Phone/Fax

Practice location:
  • Phone: 808-378-4869
  • Fax: 808-320-3329
Mailing address:
  • Phone: 808-378-4869
  • Fax: 808-320-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RANDALL P JAUREQUI
Title or Position: OWNER/ DENTIST
Credential: DDS
Phone: 808-378-4869