Healthcare Provider Details

I. General information

NPI: 1952907008
Provider Name (Legal Business Name): CHASEN DAUGHERTY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 102
HONOLULU HI
96814-1871
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 102
HONOLULU HI
96814-1871
US

V. Phone/Fax

Practice location:
  • Phone: 808-356-5699
  • Fax:
Mailing address:
  • Phone: 808-356-5699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLKJ
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberAMD-1049
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: