Provider Demographics
NPI:1336206960
Name:KIM, YOUNG RHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YOUNG
Middle Name:RHAN
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 ULULANI ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3913
Mailing Address - Country:US
Mailing Address - Phone:808-935-3909
Mailing Address - Fax:808-961-3995
Practice Address - Street 1:868 ULULANI ST
Practice Address - Street 2:SUITE 109
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3913
Practice Address - Country:US
Practice Address - Phone:808-935-3909
Practice Address - Fax:808-961-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03095301Medicaid
HIF82440Medicare UPIN
HI03095301Medicaid