Provider Demographics
NPI:1790190528
Name:KIM, HYELEE (PSYCHIATRIC NP)
Entity Type:Individual
Prefix:
First Name:HYELEE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PSYCHIATRIC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1246 AKELE ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4221
Mailing Address - Country:US
Mailing Address - Phone:760-583-1997
Mailing Address - Fax:
Practice Address - Street 1:30 AULIKE ST STE 308
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:760-583-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574628163WP0809X
CA95001174363LP0808X
HI2189363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult