Healthcare Provider Details

I. General information

NPI: 1285288126
Provider Name (Legal Business Name): LANDON MATSUYOSHI OKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-720 LANIKUHANA AVE STE 230
MILILANI HI
96789-2984
US

IV. Provider business mailing address

1496 KAWELOKA ST
PEARL CITY HI
96782-1514
US

V. Phone/Fax

Practice location:
  • Phone: 808-635-6333
  • Fax:
Mailing address:
  • Phone: 808-381-7728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2812
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: