Basic Information
Provider Information | |||||||||
NPI: | 1063475796 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HIGA | ||||||||
FirstName: | BRIAN | ||||||||
MiddleName: | M. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 244 HAILI STREET | ||||||||
Address2: | BLDG B | ||||||||
City: | HILO | ||||||||
State: | HI | ||||||||
PostalCode: | 967202975 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8089614071 | ||||||||
FaxNumber: | 8089615167 | ||||||||
Practice Location | |||||||||
Address1: | 16-192 PILIMUA ST | ||||||||
Address2: |   | ||||||||
City: | KEAAU | ||||||||
State: | HI | ||||||||
PostalCode: | 96749 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8089300418 | ||||||||
FaxNumber: | 8089615167 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/12/2006 | ||||||||
LastUpdateDate: | 04/18/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DT2109 | HI | Y |   | Dental Providers | Dentist |   |
ID Information
ID | Type | State | Issuer | Description | 571176 | 05 | HI |   | MEDICAID | 2109 | 01 | HI | HDS | OTHER | 0000251041 | 01 | HI | HMSA | OTHER |