Provider Demographics
NPI:1780712521
Name:DREAMWALK CORP.
Entity type:Organization
Organization Name:DREAMWALK CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHONG
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:808-969-3100
Mailing Address - Street 1:41 LAIMANA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2542
Mailing Address - Country:US
Mailing Address - Phone:808-969-3100
Mailing Address - Fax:808-935-3900
Practice Address - Street 1:41 LAIMANA ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2542
Practice Address - Country:US
Practice Address - Phone:808-969-3100
Practice Address - Fax:808-935-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02436401OtherALOHA CARE
HI02436401Medicaid
HI0508310004OtherHMAA
HI02436402Medicaid
HI02436401OtherALOHA CARE
HI4127440001Medicare ID - Type Unspecified