Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 947 | HI |
NPI | 1386793255 |
---|---|
Provider Name | Walton Shim |
First Address | Honolulu, HI 96825-0668 |
Second Address | Honolulu, HI 96826-1077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02753201 | (05) | HI |