Provider Demographics
NPI:1124110507
Name:TIMTIM, JOHN K (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:K
Last Name:TIMTIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 KALANIANAOLE HWY STE 111
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1278
Mailing Address - Country:US
Mailing Address - Phone:808-432-3700
Mailing Address - Fax:
Practice Address - Street 1:6700 KALANIANAOLE HWY STE 111
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1278
Practice Address - Country:US
Practice Address - Phone:808-432-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-5752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000062638OtherHMSA BILLING NUMBER
HI054284-02Medicaid
HIH0000BDQPVMedicare PIN
HI054284-02Medicaid