Healthcare Provider Details

I. General information

NPI: 1730616632
Provider Name (Legal Business Name): YUMI KIM PANUI LCSW, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154TH WG HIANG 360 MAMALA BAY DR. BLDG. 3382, RM. 212
JBPHH HI
96853-5517
US

IV. Provider business mailing address

154TH WG HIANG 360 MAMALA BAY DR. BLDG. 3382, RM. 212
JBPHH HI
96853-5517
US

V. Phone/Fax

Practice location:
  • Phone: 808-448-8141
  • Fax:
Mailing address:
  • Phone: 808-448-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1260-05
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4097
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: