Individual provider Active NPI

Gordon Kanemaru, D.D.S.

  • General Practice Dentistry
  • Wahiawa, HI
National Provider Identifier
1205986692
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
1810 Issued in HI
Practice address
410 Kilani Ave
Suite 221
Wahiawa, HI 96786-1844
Phone
(808) 622-4354
Fax
(808) 622-0555
NPI assigned
Jan 10, 2007
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 1810 HI Primary

Addresses

Primary practice location

410 Kilani Ave
Suite 221
Wahiawa, HI 96786-1844

Mailing address

410 Kilani Ave
Suite 221
Wahiawa, HI 96786-1844
Phone (808) 622-4354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1810HIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1205986692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 KILANI AVE",
            "address_2": "SUITE 221",
            "city": "WAHIAWA",
            "state": "HI",
            "postal_code": "967861844",
            "telephone_number": "808-622-4354",
            "fax_number": "808-622-0555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 KILANI AVE",
            "address_2": "SUITE 221",
            "city": "WAHIAWA",
            "state": "HI",
            "postal_code": "967861844",
            "telephone_number": "808-622-4354",
            "fax_number": "808-622-0555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANEMARU",
        "first_name": "GORDON",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "1810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wahiawa, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.