Healthcare Provider Details

I. General information

NPI: 1336572395
Provider Name (Legal Business Name): CHARLES LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 WARD AVE STE 600
HONOLULU HI
96814-2193
US

IV. Provider business mailing address

932 WARD AVE STE 600
HONOLULU HI
96814-2193
US

V. Phone/Fax

Practice location:
  • Phone: 808-535-5555
  • Fax:
Mailing address:
  • Phone: 808-535-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-1816
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: