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General NPI Number Information
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NPI Number | 1356304000
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Entity Type | Individual
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Provider Name | JASON KAOPUA DMD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 16-192 PILI MUA ST KEAAU FAMILY HEALTH CENTER
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City | KEAAU
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State | HI
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Zip | 96749
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Country | US
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Telephone | 808-930-0400
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Fax | 808-934-3238
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Provider Business Mailing Address
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Address Line | 311 KALANIANAOLE AVE BAY CLINIC INC
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City | HILO
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State | HI
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Zip | 96720
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Country | US
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Telephone | 808-930-0419
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Fax | 808-961-5167
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DT2042
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License Number State | HI
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