Provider Demographics
NPI:1780780049
Name:YIM, ROGER E (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:E
Last Name:YIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LUSITANA STREET
Mailing Address - Street 2:SUITE 704
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2431
Mailing Address - Country:US
Mailing Address - Phone:808-524-2100
Mailing Address - Fax:808-534-0593
Practice Address - Street 1:1329 LUSITANA STREET
Practice Address - Street 2:SUITE 704
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2431
Practice Address - Country:US
Practice Address - Phone:808-524-2100
Practice Address - Fax:808-534-0593
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10400207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI22987-2OtherHMSA
HI499104-01Medicaid
HIHGDRUGEROtherMEDICARE GROUP PROVIDER
HI10400OtherMDX QUEENS HEALTH CARE
HIH55623Medicare ID - Type Unspecified
HI10400OtherMDX QUEENS HEALTH CARE