Healthcare Provider Details

I. General information

NPI: 1356268569
Provider Name (Legal Business Name): TAE WOO KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1080
US

IV. Provider business mailing address

1319 PUNAHOU ST
HONOLULU HI
96826-1028
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPH-2270
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: