Basic Information
| Provider Information | |||||||||
| NPI: | 1225295181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | KEISUNG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 OAK ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139841800 | ||||||||
| FaxNumber: | 5139841800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 KAPIOLANI BLVD STE 1600 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968144407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084327600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2008 | ||||||||
| LastUpdateDate: | 08/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | 835 | HI | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | 835 | HI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.