Healthcare Provider Details

I. General information

NPI: 1972704476
Provider Name (Legal Business Name): SIMON B KIM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 606
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-951-9931
  • Fax: 808-951-9930
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13022
License Number StateHI

VIII. Authorized Official

Name: ANNETTE MOANANU
Title or Position: MEDICAL BILLER
Credential:
Phone: 808-536-0300