Healthcare Provider Details

I. General information

NPI: 1154158251
Provider Name (Legal Business Name): OHANA DENTAL OF WAIPAHU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/14/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-050 FARRINGTON HWY STE E1-2
WAIPAHU HI
96797-1842
US

IV. Provider business mailing address

1000 AUAHI ST APT 3806
HONOLULU HI
96814-3378
US

V. Phone/Fax

Practice location:
  • Phone: 808-677-2451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELLIOT KIM
Title or Position: OWNER DENTIST
Credential: DDS
Phone: 808-277-9026