Provider Demographics
NPI:1992197057
Name:KIM, JAE HWAN (NP-C, APRX-RX)
Entity Type:Individual
Prefix:MR
First Name:JAE HWAN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:NP-C, APRX-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ATKINSON DR. LEVEL 3
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-498-7913
Mailing Address - Fax:808-748-0302
Practice Address - Street 1:410 ATKINSON DR. LEVEL 3
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-498-7913
Practice Address - Fax:808-748-0302
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-1886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily