Healthcare Provider Details

I. General information

NPI: 1023083540
Provider Name (Legal Business Name): INEZ HANAKO SUEHISA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CALIFORNIA AVE 204
WAHIAWA HI
96786-1841
US

IV. Provider business mailing address

95-441 AWIKI ST
MILILANI HI
96789-1857
US

V. Phone/Fax

Practice location:
  • Phone: 808-622-2633
  • Fax:
Mailing address:
  • Phone: 808-627-1656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-1975
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: