Provider Demographics
NPI:1609533033
Name:KIM, ALEX SR
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:KIM
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 WAIALAE AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1852
Mailing Address - Country:US
Mailing Address - Phone:808-219-5355
Mailing Address - Fax:
Practice Address - Street 1:2860 WAIALAE AVE APT 215
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1852
Practice Address - Country:US
Practice Address - Phone:808-219-5355
Practice Address - Fax:808-744-6448
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2023-11-30
Deactivation Date:2023-09-28
Deactivation Code:
Reactivation Date:2023-11-24
Provider Licenses
StateLicense IDTaxonomies
171100000X
HIACU-1344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIXLQ0002106211Medicaid
ACU-1344OtherACUPUNCTURIST