Provider Demographics
NPI:1861596264
Name:GHIM, ANTHONY TONGWON (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TONGWON
Last Name:GHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15TH MDG
Mailing Address - Street 2:755 SCOTT CIRCLE
Mailing Address - City:JBPH-HICKAM
Mailing Address - State:HI
Mailing Address - Zip Code:96853
Mailing Address - Country:US
Mailing Address - Phone:808-448-6776
Mailing Address - Fax:808-448-6113
Practice Address - Street 1:15TH MDG
Practice Address - Street 2:755 SCOTT CIRCLE
Practice Address - City:JBPH-HICKAM
Practice Address - State:HI
Practice Address - Zip Code:96853
Practice Address - Country:US
Practice Address - Phone:808-448-6776
Practice Address - Fax:808-448-6113
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI89242083A0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine