Provider Demographics
NPI:1952474181
Name:JICHAKU, ALAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:JICHAKU
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 1:2875 S KING ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3564
Mailing Address - Country:US
Mailing Address - Phone:808-942-1144
Mailing Address - Fax:
Practice Address - Street 1:2875 S KING ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3564
Practice Address - Country:US
Practice Address - Phone:808-942-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist