Healthcare Provider Details

I. General information

NPI: 1659050391
Provider Name (Legal Business Name): JONATHAN PAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 7-400
HONOLULU HI
96813-4902
US

IV. Provider business mailing address

3464 MANOA RD
HONOLULU HI
96822-1129
US

V. Phone/Fax

Practice location:
  • Phone: 808-861-4287
  • Fax:
Mailing address:
  • Phone: 808-347-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: