Healthcare Provider Details

I. General information

NPI: 1992627897
Provider Name (Legal Business Name): JENSEN CODI WILLS-CHING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 KUNEHI ST APT 206
KAPOLEI HI
96707-2069
US

IV. Provider business mailing address

85-149 ALA AKAU ST APT E
WAIANAE HI
96792-2305
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-6641
  • Fax:
Mailing address:
  • Phone: 808-485-7419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: