Provider Demographics
NPI:1083691174
Name:KIM, HELEN HAEKYUNG (MD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:HAEKYUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HAE
Other - Middle Name:KYUNG
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1401 S BERETANIA ST STE 350
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1871
Mailing Address - Country:US
Mailing Address - Phone:808-941-2244
Mailing Address - Fax:
Practice Address - Street 1:1401 S BERETANIA ST STE 350
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1871
Practice Address - Country:US
Practice Address - Phone:808-941-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049343207Q00000X
AZ34657207Q00000X
HIMD-21675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT049343OtherCT LICENSE
AZ34657OtherSTATE LICENSE NUMBRE
CAA67884OtherLICENSE
H78506Medicare UPIN