Provider Demographics
NPI:1780748582
Name:OUCHI, KIMMIE S (MD)
Entity type:Individual
Prefix:DR
First Name:KIMMIE
Middle Name:S
Last Name:OUCHI
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 1:910 WAINEE ST
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1622
Mailing Address - Country:US
Mailing Address - Phone:808-662-6900
Mailing Address - Fax:
Practice Address - Street 1:910 WAINEE ST
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1622
Practice Address - Country:US
Practice Address - Phone:808-662-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-12379207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000242347OtherHMSA BILLING NUMBER
HI539348-03Medicaid
HIH92425Medicare UPIN
HI539348-03Medicaid