Basic Information
| Provider Information | |||||||||
| NPI: | 1770567570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INOUYE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN SAYA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7101 HOFF STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 HOFF STREET | ||||||||
| Address2: | USA DENTAC | ||||||||
| City: | FT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065444530 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2166 | HI | N | Dental Providers | Dentist | 1223P0300X | DT-2166 | HI | Y | Dental Providers | Dentist | Periodontics |
No ID Information.