Provider Demographics
NPI:1417254376
Name:MISAILIDIS, SOO JEAN CHOI (PHD)
Entity Type:Individual
Prefix:DR
First Name:SOO JEAN
Middle Name:CHOI
Last Name:MISAILIDIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SOO JEAN
Other - Middle Name:
Other - Last Name:CHOI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-983-6100
Mailing Address - Fax:808-983-6105
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:SUITE 950
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-983-6100
Practice Address - Fax:808-983-6105
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-1024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical