Provider Demographics
NPI:1912562513
Name:DR ATHENA KIM LLC
Entity Type:Organization
Organization Name:DR ATHENA KIM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM-ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:808-753-8355
Mailing Address - Street 1:PO BOX 22393
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96823-2393
Mailing Address - Country:US
Mailing Address - Phone:808-753-8355
Mailing Address - Fax:
Practice Address - Street 1:1029 KAPAHULU AVE STE 406
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-753-8355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health