Provider Demographics
NPI:1013918291
Name:TAKEMOTO-CHOCK, NAOMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:TAKEMOTO-CHOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1978 KOMOHANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5941
Mailing Address - Country:US
Mailing Address - Phone:808-959-4948
Mailing Address - Fax:
Practice Address - Street 1:1978 KOMOHANA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5941
Practice Address - Country:US
Practice Address - Phone:808-959-4948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI333103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02373701Medicaid
HIH0000TCBVFMedicare PIN