MEDICARE: DR. TAMMIE A KIM PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY785	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	56534301	OTHER		ALOHACARE
2	TRICARE	OTHER	HI	239236
3	239236	OTHER	HI	HMSA QUEST
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	239236	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1821038506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMIE A KIM PSY.D.

Provider Business Mailing Address
First Line	:	4747 KILAUEA AVE
Second Line	:	SUITE 108
City	:	HONOLULU
State	:	HI
Zip	:	96816
Country	:	US
Telephone Number	:	808-392-6093
Fax Number	:	808-373-5323

Provider Business Practice Location Address
First Line	:	4747 KILAUEA AVE
Second Line	:	SUITE 108
City	:	HONOLULU
State	:	HI
Zip	:	96816-5308
Country	:	US
Telephone Number	:	808-392-6093
Fax Number	:	808-373-5323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	02/04/2011

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