Healthcare Provider Details

I. General information

NPI: 1912533167
Provider Name (Legal Business Name): JOHN S. CHOCK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 HOBRON LN
HONOLULU HI
96815-1233
US

IV. Provider business mailing address

1948 NEHOA PL
HONOLULU HI
96822-3068
US

V. Phone/Fax

Practice location:
  • Phone: 808-284-0455
  • Fax: 808-564-0055
Mailing address:
  • Phone: 808-284-0455
  • Fax: 808-564-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN S CHOCK
Title or Position: MANAGER
Credential: MHC
Phone: 808-284-0455