Provider Demographics
NPI:1215775978
Name:YEUN, KELLY JEAN (RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:YEUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 PAHEE ST
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-2018
Mailing Address - Country:US
Mailing Address - Phone:702-246-0497
Mailing Address - Fax:808-246-9349
Practice Address - Street 1:4485 PAHEE ST
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-2018
Practice Address - Country:US
Practice Address - Phone:808-246-0497
Practice Address - Fax:808-246-9349
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI94142163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse