Active NPI
Brian Koshiro Matsumoto, DDS
- General Practice Dentistry
- Honolulu, HI
National Provider Identifier
1659897049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DT-2715
- Practice address
- 500 Ala Moana Boulevard
Seven Waterfront Plaza, #220
Honolulu, HI 96813 - Phone
- (808) 523-3104
- Fax
- (808) 523-3121
- NPI assigned
- Aug 17, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DT-2715 | HI | Primary |
Addresses
Primary practice location
500 Ala Moana Boulevard
Seven Waterfront Plaza, #220
Honolulu, HI 96813
Mailing address
11611 Iowa Ave
#14
Los Angeles, CA 90025
Phone (310) 948-9394
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
| License | State | Type | Specialty |
|---|---|---|---|
| DT-2715 | HI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1502928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1502928000000",
"number": "1659897049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11611 IOWA AVE",
"address_2": "#14",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90025",
"telephone_number": "310-948-9394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 ALA MOANA BOULEVARD",
"address_2": "SEVEN WATERFRONT PLAZA, #220",
"city": "HONOLULU",
"state": "HI",
"postal_code": "96813",
"telephone_number": "808-523-3104",
"fax_number": "808-523-3121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATSUMOTO",
"first_name": "BRIAN",
"middle_name": "KOSHIRO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-17",
"last_updated": "2017-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "DT-2715",
"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 Aug 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.