Healthcare Provider Details

I. General information

NPI: 1659803674
Provider Name (Legal Business Name): JANI MIJIN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 PIIKOI ST
HONOLULU HI
96814-4245
US

IV. Provider business mailing address

PO BOX 37056
HONOLULU HI
96837-0056
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-7111
  • Fax:
Mailing address:
  • Phone: 808-531-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD-22400-0
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: