Basic Information
Provider Information
NPI: 1003142613
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KUMASAKA
FirstName: DEAN
MiddleName: S
NamePrefix: MR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 459 PATTERSON RD
Address2:  
City: HONOLULU
State: HI
PostalCode: 968191522
CountryCode: US
TelephoneNumber: 8084330766
FaxNumber:  
Practice Location
Address1: 459 PATTERSON RD
Address2:  
City: HONOLULU
State: HI
PostalCode: 968191522
CountryCode: US
TelephoneNumber: 8084330766
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/02/2009
LastUpdateDate: 11/02/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X912HIY Pharmacy Service ProvidersPharmacist 

No ID Information.


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