MEDICARE: SCOTT KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PH-1976	HI

General Provider Information

NPI Number	:	1184214959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT KIM

Provider Business Mailing Address
First Line	:	PO BOX 38029
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96837-1029
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST STE 802
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96813-3303
Country	:	US
Telephone Number	:	808-523-7088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2021
Last Update Date	:	01/25/2021

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Directions to “ SCOTT KIM ” Practice Location

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