MEDICARE: HA THANH KIM D.M.D.

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	1223G0001X	General Practice Dentistry	DT1964	HI

General Provider Information

NPI Number	:	1518049402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HA THANH KIM D.M.D.

Provider Business Mailing Address
First Line	:	5285 KILAUEA AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5612
Country	:	US
Telephone Number	:	808-222-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 KAMEHAMEHA HWY
Second Line	:	#235
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2881
Country	:	US
Telephone Number	:	808-456-5953
Fax Number	:

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/01/2011

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