Provider Demographics
NPI:1437398583
Name:CHARLES OCK KIM JR MD LLC
Entity Type:Organization
Organization Name:CHARLES OCK KIM JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:OCK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:808-255-8853
Mailing Address - Street 1:707 RICHARDS ST STE 517
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4623
Mailing Address - Country:US
Mailing Address - Phone:808-255-8853
Mailing Address - Fax:
Practice Address - Street 1:707 RICHARDS ST STE 517
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4623
Practice Address - Country:US
Practice Address - Phone:808-255-8853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10159208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIG75839Medicare UPIN