Provider Demographics
NPI:1144679630
Name:TOM, IRIS KIMIE (RN)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:KIMIE
Last Name:TOM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:KIMIE
Other - Last Name:MUKAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1139 WANAKA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2836
Mailing Address - Country:US
Mailing Address - Phone:808-428-0306
Mailing Address - Fax:
Practice Address - Street 1:98-023 HEKAHA ST STE 1
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4902
Practice Address - Country:US
Practice Address - Phone:808-422-2802
Practice Address - Fax:808-484-9076
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-35749163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse