Provider Demographics
NPI:1528085222
Name:WINDWARD PEDIATRICS, INC.
Entity type:Organization
Organization Name:WINDWARD PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KY
Authorized Official - Last Name:YIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-247-6644
Mailing Address - Street 1:45-710 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2947
Mailing Address - Country:US
Mailing Address - Phone:808-247-6644
Mailing Address - Fax:808-235-2566
Practice Address - Street 1:45-710 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2947
Practice Address - Country:US
Practice Address - Phone:808-247-6644
Practice Address - Fax:808-235-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03752002Medicaid
HI03752002Medicaid