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General NPI Number Information
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NPI Number | 1013135177
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Entity Type | Organization
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Legal Business Name | KEVIN M. MIZOGUCHI, DDS, LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 615 PIIKOI ST SUITE 507
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City | HONOLULU
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State | HI
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Zip | 96814-3116
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Country | US
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Telephone | 808-596-8020
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Fax | 808-597-6149
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Provider Business Mailing Address
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Address Line | 615 PIIKOI ST SUITE 507
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City | HONOLULU
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State | HI
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Zip | 96814-3116
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Country | US
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Telephone | 808-596-8020
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Fax | 808-597-6149
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN M. MIZOGUCHI
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Credential | D.D.S.
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Telephone | 808-596-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT-1450
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License Number State | HI
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