Active NPI
Koa Yamashita
- Dentist
- Honolulu, HI
National Provider Identifier
1336554435
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DTT 243
- Practice address
- 1301 Punchbowl St
Honolulu, HI 96813-2402 - Phone
- (808) 691-4292
- Fax
- (808) 691-5028
- NPI assigned
- Jun 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DTT 243 | HI | Primary |
Addresses
Primary practice location
1301 Punchbowl St
Honolulu, HI 96813-2402
Mailing address
1301 Punchbowl St
Honolulu, HI 96813-2402
Phone (808) 691-4292
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160422001856 | HI | Order and Referring Only - Dentist | 0244539328 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DTT 243 | HI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403740800000",
"number": "1336554435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 PUNCHBOWL ST",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968132402",
"telephone_number": "808-691-4292",
"fax_number": "808-691-5028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 PUNCHBOWL ST",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968132402",
"telephone_number": "808-691-4292",
"fax_number": "808-691-5028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YAMASHITA",
"first_name": "KOA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-26",
"last_updated": "2014-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "HI",
"license": "DTT 243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.