Provider Demographics
NPI:1861531782
Name:MCKIM, CAROL L (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:MCKIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 OLOHANA ST
Mailing Address - Street 2:#2501
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2162
Mailing Address - Country:US
Mailing Address - Phone:808-955-7778
Mailing Address - Fax:808-955-7776
Practice Address - Street 1:1833 KALAKAUA AVE
Practice Address - Street 2:STE #503
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-2162
Practice Address - Country:US
Practice Address - Phone:808-955-7778
Practice Address - Fax:808-955-7776
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY802103TC0700X
CAPSY6910103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6910Medicaid
CACP6910Medicaid
HI100810Medicare ID - Type Unspecified