1518283365 NPI number — MARK DICHNER, PHD., INCORPORATED

Table of content: (NPI 1518283365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518283365 NPI number — MARK DICHNER, PHD., INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK DICHNER, PHD., INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518283365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-1009 KAIMOANA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-6071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-689-8811
Provider Business Mailing Address Fax Number:
808-689-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
92-1238 KAAHUMANU ST.
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PEARL CITY
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96782-3250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-689-8811
Provider Business Practice Location Address Fax Number:
808-689-0316
Provider Enumeration Date:
04/19/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DICHNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
808-689-8811

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY-315 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)