Healthcare Provider Details

I. General information

NPI: 1629279641
Provider Name (Legal Business Name): KELLY YQ YIM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MEYER PT, DPT

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 PUNAHOU ST
HONOLULU HI
96826-1001
US

IV. Provider business mailing address

1020 LUAWAI ST
HONOLULU HI
96816-4657
US

V. Phone/Fax

Practice location:
  • Phone: 808-983-8235
  • Fax:
Mailing address:
  • Phone: 808-220-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2484
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2484
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: