MEDICARE: JEONG H KIM, MD, PLLC

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	207RG0100X	Gastroenterology Physician	MD16105	HI

General Provider Information

NPI Number	:	1598190134
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEONG H KIM, MD, PLLC

Provider Business Mailing Address
First Line	:	1401 S BERETANIA ST STE 320
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1872
Country	:	US
Telephone Number	:	808-888-0967
Fax Number	:	808-888-0956

Provider Business Practice Location Address
First Line	:	1401 S BERETANIA ST STE 320
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1872
Country	:	US
Telephone Number	:	808-888-0967
Fax Number	:	808-888-0956

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. JEONG HWAN KIM
Credential	:	M.D.
Telephone Number	:	808-489-9479

Provider Enumeration Date	:	09/13/2013
Last Update Date	:	03/07/2023

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