1821038506 NPI number — DR. TAMMIE A KIM PSY.D.

Table of content: DR. TAMMIE A KIM PSY.D. (NPI 1821038506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821038506 NPI number — DR. TAMMIE A KIM PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
TAMMIE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
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:
1821038506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4747 KILAUEA AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-392-6093
Provider Business Mailing Address Fax Number:
808-373-5323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4747 KILAUEA AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96816-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-392-6093
Provider Business Practice Location Address Fax Number:
808-373-5323
Provider Enumeration Date:
06/08/2006

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: 103TC0700X , with the licence number:  PSY785 , 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)

  • Identifier: 56534301 . This is a "ALOHACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: TRICARE . This is a "239236" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 239236 . This is a "HMSA QUEST" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 56534301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 239236 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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