Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DIO-223 | HI |
NPI | 1124383872 |
---|---|
Provider Name | Su Yon Kim |
First Address | Honolulu, HI 96814-3008 |
Second Address | Honolulu, HI 96814-3008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 24/08/2012 |