Provider Demographics
NPI:1316058324
Name:LAU, BRIAN KW (DENTIST)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KW
Last Name:LAU
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2638
Mailing Address - Country:US
Mailing Address - Phone:808-456-8552
Mailing Address - Fax:808-456-2622
Practice Address - Street 1:803 KAMEHAMEHA HWY
Practice Address - Street 2:#300
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2638
Practice Address - Country:US
Practice Address - Phone:808-456-8552
Practice Address - Fax:808-456-2622
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI132401OtherHAWAII DENTAL SERVICE
HI01798401Medicaid
HI193301OtherHMSA