Provider Demographics
NPI:1114997251
Name:KIM, KIKU E (MD)
Entity Type:Individual
Prefix:
First Name:KIKU
Middle Name:E
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-229 WAIPAHU DEPOT ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3035
Mailing Address - Country:US
Mailing Address - Phone:503-841-5065
Mailing Address - Fax:866-824-0948
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST STE 500
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3035
Practice Address - Country:US
Practice Address - Phone:503-841-5065
Practice Address - Fax:866-824-0948
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081898K2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2242342Medicaid
OHKI4145551Medicare ID - Type Unspecified
I19806Medicare UPIN