Lisa Yukiko Shitamoto, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2477 Issued in HI

Practice address

141 Maa St Unit a
Kahului, HI 96732-3603

Phone

(808) 242-6605

Fax

(808) 242-5819

NPI assigned

Jul 6, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1341532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671062400000",
    "number": "1134484009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 MAA ST UNIT A",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967323603",
            "telephone_number": "808-242-6605",
            "fax_number": "808-242-5819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 MAA ST UNIT A",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967323603",
            "telephone_number": "808-242-6605",
            "fax_number": "808-242-5819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHITAMOTO",
        "first_name": "LISA",
        "middle_name": "YUKIKO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-06",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "2477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Maile Sheehan, MASSAGE THERAPIST
• Angela Panuiokalani Shepard
• Gabryelle Alohamaikalani Shepard
• Laurel Shiba, PHD
• Kristina Chance Shimokawa, LMFT
• Kij Sidon, DPT
• Christian May Simon, REGISTERED NURSE
• Sarah Anne Simons, AU.D.
• Laya Yelena Simpson, NURSE AIDE
• Hailey Singleton, RBT-21-155436

• General Practice Dentistry in Kahului, HI
• Providers in Kahului, HI by specialty
• General Practice Dentistry in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.