Individual provider Active NPI

Craig Shoichi Haga, DDS

  • Dentist
  • Honolulu, HI
National Provider Identifier
1275623332
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DT1690 Issued in HI
Practice address
1441 Kapiolani Blvd.
Suite 208
Honolulu, HI 96814
Phone
(808) 591-1515
Fax
(808) 593-8628
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DT1690 HI Primary

Addresses

Primary practice location

1441 Kapiolani Blvd.
Suite 208
Honolulu, HI 96814

Mailing address

1441 Kapiolani Blvd
Suite 208
Honolulu, HI 96814
Phone (808) 591-1515

Other identifiers 1

IdentifierTypeStateIssuer
51959801MedicaidHI

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
I20150904001219 HI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2163738196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DT1690HIMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Endodontic Associates, LLC PastSince Jun 25, 2023 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": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1275623332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 KAPIOLANI BLVD",
            "address_2": "SUITE 208",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96814",
            "telephone_number": "808-591-1515",
            "fax_number": "808-593-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 KAPIOLANI BLVD.",
            "address_2": "SUITE 208",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96814",
            "telephone_number": "808-591-1515",
            "fax_number": "808-593-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGA",
        "first_name": "CRAIG",
        "middle_name": "SHOICHI",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "HI",
            "license": "DT1690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51959801",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

Verify at the official NPI Registry.