Provider Demographics
NPI:1164908588
Name:CHOY, JACKILYN K (LMT, CCM)
Entity Type:Individual
Prefix:MS
First Name:JACKILYN
Middle Name:K
Last Name:CHOY
Suffix:
Gender:F
Credentials:LMT, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 KUNAWAI LN
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2292
Mailing Address - Country:US
Mailing Address - Phone:808-391-3429
Mailing Address - Fax:
Practice Address - Street 1:650 IWILEI RD STE 165
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5319
Practice Address - Country:US
Practice Address - Phone:808-391-3429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12197225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist