Individual provider Active NPI

Clifford J. Omura, D.D.S.

  • General Practice Dentistry
  • Honolulu, HI
National Provider Identifier
1073603619
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1185 Issued in HI
Practice address
1150 S King St Ste 305
Honolulu, HI 96814-1951
Phone
(808) 593-2999
NPI assigned
Oct 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1185 HI Primary

Addresses

Primary practice location

1150 S King St Ste 305
Honolulu, HI 96814-1951

Mailing address

1150 S King St Ste 305
Honolulu, HI 96814-1951
Phone (808) 593-2999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150714000843 HI Order and Referring Only - DentistPractitioner - Dentist 7911210497

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1185HIMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Omura & Inouye, D.D.S., Inc. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073603619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 S KING ST STE 305",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968141951",
            "telephone_number": "808-593-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 S KING ST STE 305",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968141951",
            "telephone_number": "808-593-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMURA",
        "first_name": "CLIFFORD",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "1185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.