MEDICARE: DR. JAMES M SAGAWA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	740	HI
2	1223G0001X	General Practice Dentistry	D4167	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B210977	OTHER	HI	HMSA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	9740	OTHER	HI	HDS
4	47198	OTHER	HI	BCBS

General Provider Information

NPI Number	:	1336113125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M SAGAWA DMD

Provider Business Mailing Address
First Line	:	PO BOX 630117
Second Line	:
City	:	LANAI CITY
State	:	HI
Zip	:	96763-0117
Country	:	US
Telephone Number	:	808-565-6418
Fax Number	:	808-565-6742

Provider Business Practice Location Address
First Line	:	730 LANAI AVENUE
Second Line	:	SUITE #101
City	:	LANAI CITY
State	:	HI
Zip	:	96763-0117
Country	:	US
Telephone Number	:	808-565-6418
Fax Number	:	808-565-6418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/08/2007

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