Provider Demographics
NPI:1407923238
Name:SHIM, MELANIE L (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:L
Last Name:SHIM
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 1:2828 PAA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4430
Mailing Address - Country:US
Mailing Address - Phone:808-432-5777
Mailing Address - Fax:
Practice Address - Street 1:2828 PAA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4430
Practice Address - Country:US
Practice Address - Phone:808-432-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA606812080P0205X
HIMD-163352080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology