NPIMap

Organization Active NPI

Mark K. Koizumi, D.D.S., Inc.

  • Dental Clinic/Center
  • Hilo, HI
National Provider Identifier
1538373972
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DT-1380 Issued in HI
Legal business name
MARK K. KOIZUMI, D.D.S., INC.
Practice address
275 Ponahawai St
Suite 103
Hilo, HI 96720-3074
Phone
(808) 935-1149
NPI assigned
May 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Dr. Mark K. Koizumi, D.D.S.NPI 1366797425
Title
President
Phone
(808) 935-1149

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DT-1380 HI Primary

Addresses

Primary practice location

275 Ponahawai St
Suite 103
Hilo, HI 96720-3074

Mailing address

275 Ponahawai St
Suite 103
Hilo, HI 96720-3074
Phone (808) 935-1149

National Provider Directory

National Provider Directory

Locations

275 Ponahawai St
Ste 103
Hilo, HI 96720
Phone (808) 935-1149

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1538373972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 PONAHAWAI ST",
            "address_2": "SUITE 103",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967203074",
            "telephone_number": "808-935-1149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 PONAHAWAI ST",
            "address_2": "SUITE 103",
            "city": "HILO",
            "state": "HI",
            "postal_code": "967203074",
            "telephone_number": "808-935-1149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK K. KOIZUMI, D.D.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "KOIZUMI",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-935-1149",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "HI",
            "license": "DT-1380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hilo, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.