Healthcare Provider Details

I. General information

NPI: 1932044120
Provider Name (Legal Business Name): CHAD BOGARDUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 KEALAHOU ST
HONOLULU HI
96825-2966
US

IV. Provider business mailing address

818 KEALAHOU ST
HONOLULU HI
96825-2966
US

V. Phone/Fax

Practice location:
  • Phone: 510-710-0649
  • Fax:
Mailing address:
  • Phone: 510-710-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-78093
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: