Healthcare Provider Details

I. General information

NPI: 1912612185
Provider Name (Legal Business Name): ADVANCED MIND & BODY SPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-080 KAUHALE ST STE C17
AIEA HI
96701-4117
US

IV. Provider business mailing address

99-080 KAUHALE ST STE C17
AIEA HI
96701-4117
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-1070
  • Fax: 808-488-9301
Mailing address:
  • Phone: 808-485-1070
  • Fax: 808-488-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CINDY M CHANG
Title or Position: PRESIDENT
Credential: L.A,C
Phone: 808-485-1070