Healthcare Provider Details

I. General information

NPI: 1750099537
Provider Name (Legal Business Name): ANNA MAKALOA YIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 SALT LAKE BLVD
HONOLULU HI
96818-3195
US

IV. Provider business mailing address

1512 ALA MAHAMOE ST
HONOLULU HI
96819-1765
US

V. Phone/Fax

Practice location:
  • Phone: 808-421-4200
  • Fax:
Mailing address:
  • Phone: 808-445-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: