Provider Demographics
NPI:1356695027
Name:MCDONALD, JOACHIM (LMT)
Entity type:Individual
Prefix:
First Name:JOACHIM
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:COR
Other - Middle Name:
Other - Last Name:CRYSTALHENGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:670 PROSPECT ST APT 801
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-1912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 PROSPECT STREET APARTMENT 801
Practice Address - Street 2:
Practice Address - City:H'ONOLULU
Practice Address - State:HAWAI'I
Practice Address - Zip Code:NONE
Practice Address - Country:AX
Practice Address - Phone:808-693-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12601172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker