Healthcare Provider Details

I. General information

NPI: 1891613634
Provider Name (Legal Business Name): PAYTON KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-5259 MAMALAHOA HWY APT D2
HOLUALOA HI
96725-9643
US

IV. Provider business mailing address

75-5259 MAMALAHOA HWY APT D2
HOLUALOA HI
96725-9643
US

V. Phone/Fax

Practice location:
  • Phone: 808-464-1084
  • Fax:
Mailing address:
  • Phone: 808-464-1084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30335201
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: