Provider Demographics
NPI:1679292981
Name:KIDSHINE KAILUA LLC
Entity type:Organization
Organization Name:KIDSHINE KAILUA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CHING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-638-3313
Mailing Address - Street 1:850 KAMEHAMEHA HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2603
Mailing Address - Country:US
Mailing Address - Phone:808-638-3313
Mailing Address - Fax:
Practice Address - Street 1:25 KANEOHE BAY DR STE 109
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1711
Practice Address - Country:US
Practice Address - Phone:808-638-3313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty