Provider Demographics
NPI:1629154182
Name:YIM, PAUL MT
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MT
Last Name:YIM
Suffix:
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 1:46005 KAWA STREET
Mailing Address - Street 2:301
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3813
Mailing Address - Country:US
Mailing Address - Phone:808-235-0550
Mailing Address - Fax:808-234-1166
Practice Address - Street 1:46 005 KAWA STREET
Practice Address - Street 2:301
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3813
Practice Address - Country:US
Practice Address - Phone:808-235-0550
Practice Address - Fax:808-234-1166
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51960501Medicaid
819742OtherUCCI
HI116401OtherHDS
HI14498OtherHMSA