Healthcare Provider Details

I. General information

NPI: 1598677171
Provider Name (Legal Business Name): ZACHARY MANDRYK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST STE 1654
HONOLULU HI
96814-1950
US

IV. Provider business mailing address

1314 S KING ST STE 1654
HONOLULU HI
96814-1950
US

V. Phone/Fax

Practice location:
  • Phone: 808-924-7246
  • Fax: 833-849-4198
Mailing address:
  • Phone: 808-924-7246
  • Fax: 833-849-4198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-14808
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: