Healthcare Provider Details

I. General information

NPI: 1780180414
Provider Name (Legal Business Name): MR. KRZYSTOF CHIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date: 09/24/2020
Reactivation Date: 10/13/2025

III. Provider practice location address

1221 KAPIOLANI BLVD PH 50
HONOLULU HI
96814-3518
US

IV. Provider business mailing address

22 LONG RIDGE RD
STAMFORD CT
06905-3812
US

V. Phone/Fax

Practice location:
  • Phone: 808-260-9893
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: