Provider Demographics
NPI:1376612564
Name:KIM, AIMEE JUNG AE (DMD)
Entity Type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:JUNG AE
Last Name:KIM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3244
Mailing Address - Country:US
Mailing Address - Phone:808-235-3131
Mailing Address - Fax:808-231-0127
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3244
Practice Address - Country:US
Practice Address - Phone:808-235-3131
Practice Address - Fax:808-234-0127
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI585044Medicaid