Healthcare Provider Details

I. General information

NPI: 1881404242
Provider Name (Legal Business Name): DERMSPACE HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
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 TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAITLYN YIM
Title or Position: OWNER
Credential: MD
Phone: 808-451-3178