Active NPI
Brian Seigo Kubo, DDS
- Dentist
- Kamuela, HI
National Provider Identifier
1861533028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DT-1795
- Practice address
- 65-1230 Mamalahoa Hwy A21
Kamuela, HI 96743-7317 - Phone
- (808) 885-8465
- Fax
- (808) 885-8470
- NPI assigned
- Feb 9, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DT-1795 | HI | Primary |
Addresses
Primary practice location
65-1230 Mamalahoa Hwy A21
Kamuela, HI 96743-7317
Mailing address
65-1230 Mamalahoa Hwy A21
Kamuela, HI 96743-7317
Phone (808) 885-8465
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 |
|---|---|---|---|---|
| I20160112001154 | HI | Order and Referring Only - Oral Surgery | 8022310747 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DT-1795 | HI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596412800000",
"number": "1861533028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65-1230 MAMALAHOA HWY A21",
"city": "KAMUELA",
"state": "HI",
"postal_code": "967437317",
"telephone_number": "808-885-8465",
"fax_number": "808-885-8470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65-1230 MAMALAHOA HWY A21",
"city": "KAMUELA",
"state": "HI",
"postal_code": "967437317",
"telephone_number": "808-885-8465",
"fax_number": "808-885-8470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBO",
"first_name": "BRIAN",
"middle_name": "SEIGO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2020-08-03",
"certification_date": "2020-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "HI",
"license": "DT-1795",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kamuela, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.