Provider Demographics
NPI:1215430160
Name:KIM, NATHAN DONGSUN (PA)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:DONGSUN
Last Name:KIM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:683 WAIANAE AVE
Mailing Address - Street 2:DDHC 3RD BRIGADE SCMH
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96786-6000
Mailing Address - Country:US
Mailing Address - Phone:088-433-8255
Mailing Address - Fax:
Practice Address - Street 1:683 WAIANAE AVE BLDG 677
Practice Address - Street 2:DDHC 3RD BRIGADE SCMH
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96786-6000
Practice Address - Country:US
Practice Address - Phone:808-433-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1149098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant