Healthcare Provider Details

I. General information

NPI: 1710938675
Provider Name (Legal Business Name): MICHAEL YICK TIM YEE M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 ULUKAHIKI ST # 211
KAILUA HI
96734-4400
US

IV. Provider business mailing address

642 ULUKAHIKI ST # 211
KAILUA HI
96734-4400
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-0765
  • Fax: 808-262-5636
Mailing address:
  • Phone: 808-261-0765
  • Fax: 808-262-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5733
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: