MEDICARE: OLIVIA SOOHYUN KIM RPH

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	86238	CA

General Provider Information

NPI Number	:	1316641640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA SOOHYUN KIM RPH

Provider Business Mailing Address
First Line	:	4046 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4907
Country	:	US
Telephone Number	:	310-391-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	4046 S CENTINELA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4907
Country	:	US
Telephone Number	:	310-391-0255
Fax Number	:

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

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	03/29/2023

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