Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | ACU-1344 | HI |
NPI | 1609533033 |
---|---|
Provider Name | Mr. Alex Kim SR. |
First Address | Honolulu, HI 96826-1852 |
Second Address | Honolulu, HI 96826-1852 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2021 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XLQ0002106211 | (05) | HI |