Provider Demographics
NPI:1598190134
Name:JEONG H KIM, MD, PLLC
Entity Type:Organization
Organization Name:JEONG H KIM, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:HWAN
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-489-9479
Mailing Address - Street 1:1401 S BERETANIA ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1872
Mailing Address - Country:US
Mailing Address - Phone:808-888-0967
Mailing Address - Fax:808-888-0956
Practice Address - Street 1:1401 S BERETANIA ST STE 320
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1872
Practice Address - Country:US
Practice Address - Phone:808-888-0967
Practice Address - Fax:808-888-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD16105207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIFK1974181OtherDEA
HIH104155Medicare PIN