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1629279641 NPI number — KELLY YQ YIM DPT

NPI Number: 1629279641
Health Care Provider/Practitioner: KELLY YQ YIM DPT

Information about “1629279641” NPI (KELLY YQ YIM DPT) exists in 1629279641 in HTML format HTML  |  1629279641 in plain Text format TXT  |  1629279641 in PDF (Portable Document Format) PDF  |  1629279641 in an XML format XML  formats.

NPI Number : 1629279641 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629279641",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "YIM",
    "FirstName": "KELLY",
    "MiddleName": "YQ",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "DPT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MEYER",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PT, DPT",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "1020 LUAWAI ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HONOLULU",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96816-4657",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "808-220-5873",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1319 PUNAHOU ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HONOLULU",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96826-1001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "808-983-8235",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/29/2007",
    "LastUpdateDate": "10/15/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2251P0200X",
          "TaxonomyName": "Pediatric Physical Therapist",
          "LicenseNumber": "2484",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225100000X",
          "TaxonomyName": "Physical Therapist",
          "LicenseNumber": "2484",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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