Active NPI
Jonathan William Mah, D.D.S.
- General Practice Dentistry
- Hilo, HI
National Provider Identifier
1699781872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DT 1617
- Practice address
- 111 E Puainako St
Ste. a-104
Hilo, HI 96720-5288 - Phone
- (808) 959-3433
- Fax
- (808) 959-3675
- NPI assigned
- Jul 31, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DT 1617 | HI | Primary |
Addresses
Primary practice location
111 E Puainako St
Ste. a-104
Hilo, HI 96720-5288
Mailing address
949 Ikena Cir
Honolulu, HI 96821-2555
Phone (808) 741-3225
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 61617 | Other | HI | HAWAII DENTAL SERVICE |
| L06380-4 | Other | HI | HMSA |
| 1672867 | Other | HI | UNITED CONCORDIA |
| 055406-02 | Medicaid | HI |
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 1617 | HI | MD | General Practice Dentistry |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Hilo, HI
- NPI 1992936140
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699781872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "949 IKENA CIR",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968212555",
"telephone_number": "808-741-3225",
"fax_number": "808-959-3675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E PUAINAKO ST",
"address_2": "STE. A-104",
"city": "HILO",
"state": "HI",
"postal_code": "967205288",
"telephone_number": "808-959-3433",
"fax_number": "808-959-3675"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAH",
"first_name": "JONATHAN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "DT 1617",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAWAII DENTAL SERVICE",
"identifier": "61617",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "L06380-4",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "1672867",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "055406-02",
"state": "HI"
}
],
"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 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.