MEDICARE: EUNAE KIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	A1-0005450	DE
2	183500000X	Pharmacist	0202218162	VA

General Provider Information

NPI Number	:	1063023604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNAE KIM

Provider Business Mailing Address
First Line	:	4060 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-236-0432
Fax Number	:	703-940-1626

Provider Business Practice Location Address
First Line	:	4060 CAMPBELL AVE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3424
Country	:	US
Telephone Number	:	703-236-0432
Fax Number	:	703-940-1626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	12/24/2020

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Directions to “ EUNAE KIM ” Practice Location

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