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General NPI Number Information
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NPI Number | 1063544831
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Entity Type | Organization
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Legal Business Name | KAIMUKI CENTER FOR DENTISTRY
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3221 WAIALAE AVE 376
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City | HONOLULU
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State | HI
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Zip | 96816-5842
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Country | US
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Telephone | 808-737-9032
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Fax | 808-737-0290
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Provider Business Mailing Address
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Address Line | 3221 WAIALAE AVE STE 376
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City | HONOLULU
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State | HI
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Zip | 96816-5842
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Country | US
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Telephone | 808-737-9032
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Fax | 808-737-0290
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Authorized Official
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Title or Position | DENTIST
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Name | DR. PHILIP K B TOM
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Credential | DDS
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Telephone | 808-737-9032
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1192
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License Number State | HI
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