=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417382607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRANDON T. YOKOTA,D.D.S. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2013
-----------------------------------------------------
Last Update Date | 09/06/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1943 S KING ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-946-4939
-----------------------------------------------------
Fax | 808-949-5452
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1943 S KING ST
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-946-4939
-----------------------------------------------------
Fax | 808-949-5452
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. BRANDON YOKOTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-946-4939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DT2095
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------