Active NPI
Stacey Ann Yim
- Clinical Psychologist
- Ewa Beach, HI
National Provider Identifier
1104025022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 945
- Practice address
- 91-1841 Fort Weaver Rd
Ewa Beach, HI 96706-1909 - Phone
- (808) 778-8661
- NPI assigned
- Jul 11, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 945 | HI | Primary |
Addresses
Primary practice location
91-1841 Fort Weaver Rd
Ewa Beach, HI 96706-1909
Mailing address
91-1841 Fort Weaver Rd
Ewa Beach, HI 96706-1909
Phone (808) 778-8661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 945 | HI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450310400000",
"number": "1104025022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91-1841 FORT WEAVER RD",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967061909",
"telephone_number": "808-778-8661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "91-1841 FORT WEAVER RD",
"city": "EWA BEACH",
"state": "HI",
"postal_code": "967061909",
"telephone_number": "808-778-8661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YIM",
"first_name": "STACEY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-07-11",
"last_updated": "2015-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "HI",
"license": "945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ewa Beach, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.