Provider Demographics
NPI:1871674465
Name:DICHNER, MARK DANIEL (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:DICHNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1009 KAIMOANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6071
Mailing Address - Country:US
Mailing Address - Phone:808-689-8811
Mailing Address - Fax:808-689-8811
Practice Address - Street 1:91-1009 KAIMOANA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6071
Practice Address - Country:US
Practice Address - Phone:808-689-8811
Practice Address - Fax:808-689-0316
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY315103TC0700X
HI315103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02146OtherHMSA (BLUE CROSS)