MEDICARE: MARK Y. SHIMAO, DDS, INC.

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	1694	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699009977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK Y. SHIMAO, DDS, INC.

Provider Business Mailing Address
First Line	:	91-902 FORT WEAVER RD
Second Line	:	SUITE 201
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2261
Country	:	US
Telephone Number	:	808-689-6900
Fax Number	:	808-689-8330

Provider Business Practice Location Address
First Line	:	91-902 FORT WEAVER RD
Second Line	:	SUITE 201
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2261
Country	:	US
Telephone Number	:	808-689-6900
Fax Number	:	808-689-8330

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	MARK YUJI SHIMAO
Credential	:	DDS
Telephone Number	:	808-689-6900

Provider Enumeration Date	:	09/19/2009
Last Update Date	:	09/19/2009

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