Healthcare Provider Details

I. General information

NPI: 1972737153
Provider Name (Legal Business Name): KYONG SU MIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

IV. Provider business mailing address

3382 WAIALAE AVE
HONOLULU HI
96816-2637
US

V. Phone/Fax

Practice location:
  • Phone: 808-548-7033
  • Fax:
Mailing address:
  • Phone: 808-548-7033
  • Fax: 808-548-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-19296
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD60771590
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD-19296
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: