Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DT-716 | HI |
NPI | 1073787057 |
---|---|
Provider Name | Dr. Bert M. Sumikawa |
First Address | Honolulu, HI 96814-2114 |
Second Address | Honolulu, HI 96814-2114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2008 |
Last Update Date | 21/04/2008 |