Active NPI
Mark Yuji Shimao, DDS
- General Practice Dentistry
- Ewa Beach, HI
National Provider Identifier
1780703827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1694
- Practice address
- 91-902 Fort Weaver Rd Ste 201
Ewa Beach, HI 96706-2261 - Phone
- (808) 689-6900
- Fax
- (808) 689-8330
- NPI assigned
- Mar 28, 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 | 1694 | HI | Primary |
Addresses
Primary practice location
91-902 Fort Weaver Rd Ste 201
Ewa Beach, HI 96706-2261
Mailing address
91-902 Fort Weaver Rd Ste 201
Ewa Beach, HI 96706-2261
Phone (808) 689-6900
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 721292 | Other | HI | UNITED CONCORDIA ID # |
| 1694 | Other | HI | STATE LIC. ID # |
| 81694 | Other | HI | HDS ID # |
| K9063-5 | Other | HI | HMSA ID # |
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 |
|---|---|---|---|
| 1694 | HI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mark Y. Shimao, DDS, Inc. | General Practice | Past | 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.
-
- General Practice Dentistry
- Ewa Beach, HI
- NPI 1699009977
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175040000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780703827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91-902 FORT WEAVER RD STE 201",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967062261",
"telephone_number": "808-689-6900",
"fax_number": "808-689-8330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91-902 FORT WEAVER RD STE 201",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967062261",
"telephone_number": "808-689-6900",
"fax_number": "808-689-8330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIMAO",
"first_name": "MARK",
"middle_name": "YUJI",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "HI",
"license": "1694",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID #",
"identifier": "721292",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LIC. ID #",
"identifier": "1694",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HDS ID #",
"identifier": "81694",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA ID #",
"identifier": "K9063-5",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ewa Beach, 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.