Provider Demographics
NPI:1629281225
Name:KIM, JONATHAN TAI KOOK (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:TAI KOOK
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:590 FARRINGTON HWY
Mailing Address - Street 2:UNIT 526A
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:808-674-2930
Mailing Address - Fax:808-674-2950
Practice Address - Street 1:590 FARRINGTON HWY
Practice Address - Street 2:UNIT 526A
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2009
Practice Address - Country:US
Practice Address - Phone:808-674-2930
Practice Address - Fax:808-674-2950
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI12184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH73834Medicare UPIN