Healthcare Provider Details

I. General information

NPI: 1063916252
Provider Name (Legal Business Name): KIMBERLY VU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/12/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALI MOMI HEART CENTER 98-1079 MOANALUA ROAD, SUITE 680
AIEA HI
96701
US

IV. Provider business mailing address

PALI MOMI HEART CENTER 98-1079 MOANALUA ROAD, SUITE 680
AIEA HI
96701
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-4553
  • Fax: 808-485-4447
Mailing address:
  • Phone: 808-485-4553
  • Fax: 808-485-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD-21892
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: