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General NPI Number Information
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NPI Number | 1538150099
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Entity Type | Individual
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Provider Name | KENN KANESHIRO DDS
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Gender | Male
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Dates
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Enumeration Date | 11/03/2005
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 18TH MEDICAL GROUP UNIT 5142
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City | APO
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State | AP
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Zip | 96368-5142
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Country | US
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Telephone | 98-960-4650
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 80 BOX 13688
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City | APO
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State | AP
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Zip | 96367-9998
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Country | US
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Telephone |
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DT 1907
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License Number State | HI
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