Healthcare Provider Details

I. General information

NPI: 1073798302
Provider Name (Legal Business Name): KIM ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 1515
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 1515
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-9888
  • Fax:
Mailing address:
  • Phone: 808-941-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateHI

VIII. Authorized Official

Name: DR. GERALD W.H. KIM
Title or Position: OWNER/PRESIDENT
Credential: DDS, MSD
Phone: 808-941-9888