Provider Demographics
NPI:1013661560
Name:HAWAII OPTIMUM PERFORMANCE, LLC
Entity Type:Organization
Organization Name:HAWAII OPTIMUM PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ATHLETIC TRAINER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:KT
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:ATC, LMT
Authorized Official - Phone:808-286-5708
Mailing Address - Street 1:PO BOX 235473
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-3507
Mailing Address - Country:US
Mailing Address - Phone:808-678-8467
Mailing Address - Fax:808-745-1545
Practice Address - Street 1:1212 PUNAHOU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1031
Practice Address - Country:US
Practice Address - Phone:808-678-8467
Practice Address - Fax:808-745-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty