Healthcare Provider Details

I. General information

NPI: 1275770752
Provider Name (Legal Business Name): MIND & BODY WORKS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WAUKE ST
HONOLULU HI
96815-4452
US

IV. Provider business mailing address

3340 WAUKE ST
HONOLULU HI
96815-4452
US

V. Phone/Fax

Practice location:
  • Phone: 808-923-7684
  • Fax: 866-452-8214
Mailing address:
  • Phone: 808-741-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberHI633
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD11262
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD11262
License Number StateHI
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD11262
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD11262
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberMD11262
License Number StateHI

VIII. Authorized Official

Name: DR. DAVID ERICH ROTH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-741-3031