Healthcare Provider Details

I. General information

NPI: 1841819125
Provider Name (Legal Business Name): HOHOKIMEL THWAJIK KI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4114 N 28TH ST APT 3005
PHOENIX AZ
85016-5779
US

IV. Provider business mailing address

4114 N 28TH ST APT 3005
PHOENIX AZ
85016-5779
US

V. Phone/Fax

Practice location:
  • Phone: 480-666-5545
  • Fax:
Mailing address:
  • Phone: 480-666-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LYNN SORENSON
Title or Position: CEO
Credential: LCSW
Phone: 480-666-5545