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1275393829 NPI number — KONA PERIODONTICS AND IMPLANTS

NPI Number: 1275393829
Health Care Provider/Practitioner: KONA PERIODONTICS AND IMPLANTS

Information about “1275393829” NPI (KONA PERIODONTICS AND IMPLANTS) exists in 1275393829 in HTML format HTML  |  1275393829 in plain Text format TXT  |  1275393829 in PDF (Portable Document Format) PDF  |  1275393829 in an XML format XML  formats.

NPI Number : 1275393829 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275393829",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KONA PERIODONTICS AND IMPLANTS",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1974 MOHOULI ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HILO",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96720-1924",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "77-6447 KUAKINI HWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KAILUA KONA",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96740-2227",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-329-7246",
    "PracticeLocationAddressFaxNumber": "808-461-3925",
    "EnumerationDate": "03/20/2024",
    "LastUpdateDate": "03/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "OAKLEY",
    "AuthorizedOfficialFirstName": "JEREMY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING MEMBER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DDS, MSD",
    "AuthorizedOfficialTelephoneNumber": "410-459-4046",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QD0000X",
        "TaxonomyName": "Dental Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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