Provider Demographics
NPI:1669630612
Name:YIM, HENRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:L
Last Name:YIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-710 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2947
Mailing Address - Country:US
Mailing Address - Phone:808-247-6644
Mailing Address - Fax:808-235-2566
Practice Address - Street 1:45-710 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2947
Practice Address - Country:US
Practice Address - Phone:808-247-6644
Practice Address - Fax:808-235-2566
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist