Healthcare Provider Details

I. General information

NPI: 1497874606
Provider Name (Legal Business Name): MARY W M KIM DDS MS A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 1515
HONOLULU HI
96814
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 1515
HONOLULU HI
96814
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 State

VIII. Authorized Official

Name: DR. MARY WAI MING KIM
Title or Position: PRESIDENT
Credential: DDS
Phone: 808-941-9888