Provider Demographics
NPI:1912351909
Name:MIN, KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST STE 515
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2441
Mailing Address - Country:US
Mailing Address - Phone:415-523-3859
Mailing Address - Fax:808-521-4285
Practice Address - Street 1:1380 LUSITANA ST STE 515
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2441
Practice Address - Country:US
Practice Address - Phone:415-523-3859
Practice Address - Fax:808-521-4285
Is Sole Proprietor?:No
Enumeration Date:2016-04-16
Last Update Date:2019-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-20291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine