Healthcare Provider Details

I. General information

NPI: 1427977727
Provider Name (Legal Business Name): JAYDEN PANGELINAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 HOOKALA ST
PEARL CITY HI
96782-2102
US

IV. Provider business mailing address

855 HOOKALA ST
PEARL CITY HI
96782-2102
US

V. Phone/Fax

Practice location:
  • Phone: 858-877-8190
  • Fax:
Mailing address:
  • Phone: 858-877-8190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: