Basic Information
| Provider Information | |||||||||
| NPI: | 1336113125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAGAWA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 630117 | ||||||||
| Address2: | |||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967630117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085656418 | ||||||||
| FaxNumber: | 8085656742 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 LANAI AVENUE | ||||||||
| Address2: | SUITE #101 | ||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967630117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085656418 | ||||||||
| FaxNumber: | 8085656418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 740 | HI | Y | Dental Providers | Dentist | General Practice | 1223G0001X | D4167 | OR | N | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | B210977 | 01 | HI | HMSA | OTHER | 24642101 | 05 | HI | MEDICAID | 9740 | 01 | HI | HDS | OTHER | 47198 | 01 | HI | BCBS | OTHER |