Healthcare Provider Details

I. General information

NPI: 1780197871
Provider Name (Legal Business Name): CAITLIN SAHARA LUM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KAMEHAMEHA HWY STE 155
PEARL CITY HI
96782-2657
US

IV. Provider business mailing address

PO BOX 160904
HONOLULU HI
96816-0921
US

V. Phone/Fax

Practice location:
  • Phone: 808-456-5005
  • Fax: 808-454-2569
Mailing address:
  • Phone: 808-732-2822
  • Fax: 808-732-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2728
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2728
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: