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General NPI Number Information
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NPI Number | 1578914685
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Entity Type | Individual
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Provider Name | JOHNNY CHAN
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Gender | Male
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 100 KAHELU AVE STE 112
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City | MILILANI
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State | HI
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Zip | 96789-3913
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Country | US
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Telephone | 808-625-3000
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Fax | 808-625-3006
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Provider Business Mailing Address
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Address Line | 4510 SALT LAKE BLVD STE D8
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City | HONOLULU
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State | HI
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Zip | 96818-3172
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA-587
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License Number State | HI
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