Healthcare Provider Details

I. General information

NPI: 1013661560
Provider Name (Legal Business Name): HAWAII OPTIMUM PERFORMANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 PUNAHOU ST
HONOLULU HI
96826-1031
US

IV. Provider business mailing address

PO BOX 235473
HONOLULU HI
96823-3507
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-8467
  • Fax: 808-745-1545
Mailing address:
  • Phone: 808-678-8467
  • Fax: 808-745-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN KT CHANG
Title or Position: OWNER/ATHLETIC TRAINER
Credential: ATC, LMT
Phone: 808-286-5708