Individual provider Active NPI

Aimee Jung Ae Kim, DMD

  • Endodontics
  • Kailua, HI
National Provider Identifier
1376612564
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DT2093 Issued in HI
Practice address
30 Aulike St Ste 404
Kailua, HI 96734-2751
Phone
(808) 235-3131
Fax
(808) 234-0127
NPI assigned
Nov 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endodontics 1223E0200X DT2093 HI Primary

Addresses

Primary practice location

30 Aulike St Ste 404
Kailua, HI 96734-2751

Mailing address

30 Aulike St Ste 404
Kailua, HI 96734-2751
Phone (808) 235-3131

Other practice location 1

98-150 Kaonohi St Ste C120
Aiea, HI 96701-5050
Phone (808) 439-8500

Other practice location 2

1401 S Beretania St Ste 575
Honolulu, HI 96814-1879
Phone (808) 218-6650

Other identifiers 1

IdentifierTypeStateIssuer
585044MedicaidHI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in HI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150512000757 HI Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0547589673

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DT2093HIMDEndodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Hawaii Endodontics LLC Endodontics CurrentSince May 11, 2025 Accepting new patients

Locations

30 Aulike St
Ste 404
Kailua, HI 96734
Phone (808) 235-3131

45-1144 Kamehameha Hwy
Ste 301
Kaneohe, HI 96744
Phone (808) 230-8000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1376612564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 AULIKE ST STE 404",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342751",
            "telephone_number": "808-235-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 AULIKE ST STE 404",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967342751",
            "telephone_number": "808-235-3131",
            "fax_number": "808-234-0127"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "98-150 Kaonohi St Ste C120",
            "address_purpose": "LOCATION",
            "city": "Aiea",
            "state": "HI",
            "postal_code": "967015050",
            "country_code": "US",
            "telephone_number": "808-439-8500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 S Beretania St Ste 575",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968141879",
            "country_code": "US",
            "telephone_number": "808-218-6650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "AIMEE",
        "middle_name": "JUNG AE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "HI",
            "license": "DT2093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "585044",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kailua, HI

Sources for this page

Verify at the official NPI Registry.