Provider Demographics
NPI:1649754920
Name:DINH, PHUOC HONG (LMT)
Entity Type:Individual
Prefix:
First Name:PHUOC
Middle Name:HONG
Last Name:DINH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 NUUANU AVE APT 704
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4003
Mailing Address - Country:US
Mailing Address - Phone:808-203-0766
Mailing Address - Fax:
Practice Address - Street 1:1136 UNION MALL STE 103
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2720
Practice Address - Country:US
Practice Address - Phone:808-536-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-14358225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist