Healthcare Provider Details

I. General information

NPI: 1417276866
Provider Name (Legal Business Name): CERA J KIM-SUNADA RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEEYONG KIM RN MSN

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 HALULU WAY
HONOLULU HI
96822-2144
US

IV. Provider business mailing address

2217 HALULU WAY
HONOLULU HI
96822-2144
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-0441
  • Fax:
Mailing address:
  • Phone: 808-941-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN - 25781
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: