Healthcare Provider Details

I. General information

NPI: 1104227404
Provider Name (Legal Business Name): HAWK HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WAIALAE AVE STE 360
HONOLULU HI
96816-5849
US

IV. Provider business mailing address

3221 WAIALAE AVE STE 360
HONOLULU HI
96816-5849
US

V. Phone/Fax

Practice location:
  • Phone: 808-744-2543
  • Fax: 808-748-0980
Mailing address:
  • Phone: 808-744-2543
  • Fax: 808-748-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDOS-1424
License Number StateHI

VIII. Authorized Official

Name: DR. SAMUEL HAWK
Title or Position: OWNER / PHYSICIAN
Credential: D.O.
Phone: 808-744-2543