Provider Demographics
NPI:1821038506
Name:KIM, TAMMIE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMMIE
Middle Name:A
Last Name:KIM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 KILAUEA AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-392-6093
Mailing Address - Fax:808-373-5323
Practice Address - Street 1:4747 KILAUEA AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5308
Practice Address - Country:US
Practice Address - Phone:808-392-6093
Practice Address - Fax:808-373-5323
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
56534301OtherALOHACARE
HITRICAREOther239236
HI239236OtherHMSA QUEST
HI56534301Medicaid
HI239236OtherHMSA
HIH555955Medicare ID - Type Unspecified
56534301OtherALOHACARE