Basic Information
| Provider Information | |||||||||
| NPI: | 1164833711 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIM | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | J.Y.S. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SI | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 701 ILALO ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085643970 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1319 PUNAHOU ST | ||||||||
| Address2: | KAPIOLANI PEDIATRIC ONCOLOGY | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968261001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089838551 | ||||||||
| FaxNumber: | 8089838005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2014 | ||||||||
| LastUpdateDate: | 02/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | MD-20655 | HI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
No ID Information.