Healthcare Provider Details

I. General information

NPI: 1043287881
Provider Name (Legal Business Name): CHAD D.N. YIM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45-718 KAM HWY
KANEOHE HI
96744-2947
US

IV. Provider business mailing address

45-718 KAM HWY
KANEOHE HI
96744-2947
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-6658
  • Fax: 808-234-0695
Mailing address:
  • Phone: 808-247-6658
  • Fax: 808-234-0695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1723
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: