1619063708 NPI number — MISS JUYHUN KIM PHYSICAL THERAPIST

Table of content: MISS JUYHUN KIM PHYSICAL THERAPIST (NPI 1619063708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619063708 NPI number — MISS JUYHUN KIM PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JUYHUN
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619063708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAKAWAO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96768-0472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-856-9890
Provider Business Mailing Address Fax Number:
808-427-4202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
153 E KAMEHAMEHA AVE STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAHULUI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96732-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-856-9890
Provider Business Practice Location Address Fax Number:
808-427-4202
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2598 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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