Provider Demographics
NPI:1790300614
Name:JI S KIM
Entity Type:Organization
Organization Name:JI S KIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-291-2487
Mailing Address - Street 1:95-1095 AINAMAKUA DRIVE
Mailing Address - Street 2:SUITE 5/7 A
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789
Mailing Address - Country:US
Mailing Address - Phone:808-797-3044
Mailing Address - Fax:
Practice Address - Street 1:95-1095 AINAMAKUA DRIVE
Practice Address - Street 2:SUITE 5/7 A
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789
Practice Address - Country:US
Practice Address - Phone:808-797-3044
Practice Address - Fax:808-797-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1740357755OtherNPI 1