Healthcare Provider Details

I. General information

NPI: 1639599616
Provider Name (Legal Business Name): BRANDON YIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE 501
HONOLULU HI
96813-2496
US

IV. Provider business mailing address

550 S BERETANIA ST STE 501
HONOLULU HI
96813-2496
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-8955
  • Fax:
Mailing address:
  • Phone: 808-691-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01078428A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-21132
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: