Healthcare Provider Details

I. General information

NPI: 1982388088
Provider Name (Legal Business Name): LEINA NORIKO MIZUSAWA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-779 FARRINGTON HWY STE 301
WAIPAHU HI
96797-3175
US

IV. Provider business mailing address

99-103 PAMOHO PL
AIEA HI
96701-4125
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-5555
  • Fax:
Mailing address:
  • Phone: 808-754-1159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3243
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: