Provider Demographics
NPI:1518049402
Name:KIM, HA THANH (DMD)
Entity Type:Individual
Prefix:
First Name:HA
Middle Name:THANH
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 1:5285 KILAUEA AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5612
Mailing Address - Country:US
Mailing Address - Phone:808-222-7564
Mailing Address - Fax:
Practice Address - Street 1:1000 KAMEHAMEHA HWY
Practice Address - Street 2:#235
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2881
Practice Address - Country:US
Practice Address - Phone:808-456-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT19641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice