Provider Demographics
NPI:1861533028
Name:KUBO, BRIAN SEIGO (DDS)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:SEIGO
Last Name:KUBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65-1230 MAMALAHOA HWY A21
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-7317
Mailing Address - Country:US
Mailing Address - Phone:808-885-8465
Mailing Address - Fax:808-885-8470
Practice Address - Street 1:65-1230 MAMALAHOA HWY A21
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7317
Practice Address - Country:US
Practice Address - Phone:808-885-8465
Practice Address - Fax:808-885-8470
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1795122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist