Provider Demographics
NPI:1750099537
Name:YIM, ANNA MAKALOA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MAKALOA
Last Name:YIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 ALA MAHAMOE ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-1765
Mailing Address - Country:US
Mailing Address - Phone:808-445-1775
Mailing Address - Fax:
Practice Address - Street 1:4361 SALT LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3195
Practice Address - Country:US
Practice Address - Phone:808-421-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician