Provider Demographics
NPI:1194938001
Name:KIM, ELIZA (DC)
Entity type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 HOBRON LN
Mailing Address - Street 2:STE. 315
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1229
Mailing Address - Country:US
Mailing Address - Phone:808-947-3344
Mailing Address - Fax:267-937-3344
Practice Address - Street 1:438 HOBRON LN
Practice Address - Street 2:STE. 315
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1229
Practice Address - Country:US
Practice Address - Phone:808-947-3344
Practice Address - Fax:267-937-3344
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000258749OtherHMSA
HI100351Medicare ID - Type Unspecified