Provider Demographics
NPI:1740372234
Name:THAM, VIVIEN M B (MD)
Entity type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:M B
Last Name:THAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1401 S BERETANIA ST
Mailing Address - Street 2:#560
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1870
Mailing Address - Country:US
Mailing Address - Phone:808-428-3288
Mailing Address - Fax:808-312-6308
Practice Address - Street 1:1401 S BERETANIA ST
Practice Address - Street 2:#560
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1870
Practice Address - Country:US
Practice Address - Phone:808-428-3288
Practice Address - Fax:808-312-6308
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-12121207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000237552OtherHMSA BILLING NUMBER
HI517740-01Medicaid
HI517740-01Medicaid
HI0000237552OtherHMSA BILLING NUMBER