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General NPI Number Information
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NPI Number | 1528085222
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Entity Type | Organization
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Legal Business Name | WINDWARD PEDIATRICS, INC.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/15/2007
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Provider Practice Location Address
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Address Line | 45-710 KAMEHAMEHA HWY
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City | KANEOHE
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State | HI
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Zip | 96744-2947
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Country | US
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Telephone | 808-247-6644
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Fax | 808-235-2566
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Provider Business Mailing Address
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Address Line | 45-710 KAMEHAMEHA HWY
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City | KANEOHE
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State | HI
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Zip | 96744-2947
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Country | US
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Telephone | 808-247-6644
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Fax | 808-235-2566
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. GREGORY KY YIM
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Credential | MD
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Telephone | 808-247-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD6927
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License Number State | HI
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