Healthcare Provider Details

I. General information

NPI: 1104801604
Provider Name (Legal Business Name): KALVIN YONGCHUN HUR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-615 KUPUOHI ST #206
WAIPAHU HI
96797
US

IV. Provider business mailing address

94-615 KUPUOHI ST #206
WAIPAHU HI
96797
US

V. Phone/Fax

Practice location:
  • Phone: 808-688-2888
  • Fax: 808-688-2345
Mailing address:
  • Phone: 808-688-2888
  • Fax: 808-688-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number051354
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT 2274
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: