Healthcare Provider Details

I. General information

NPI: 1174075303
Provider Name (Legal Business Name): KAITLYN YIM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST STE 1000
HONOLULU HI
96826-1077
US

IV. Provider business mailing address

1319 PUNAHOU ST STE 1000
HONOLULU HI
96826-1077
US

V. Phone/Fax

Practice location:
  • Phone: 808-451-3178
  • Fax: 808-427-6064
Mailing address:
  • Phone: 808-451-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA166454
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD-24785
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: