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General NPI Number Information
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NPI Number | 1588373120
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Entity Type | Individual
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Provider Name | LISA KIM FNP
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Gender | Female
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 550 S BERETANIA ST STE 501
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-691-8955
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Fax | 808-691-8950
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Provider Business Mailing Address
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Address Line | 550 S BERETANIA ST STE 501
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City | HONOLULU
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State | HI
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Zip | 96813-2496
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Country | US
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Telephone | 808-691-8955
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Fax | 808-691-8950
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-3873-0
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License Number State | HI
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