MEDICARE: DR. CHARLES C KIM PHARMD

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	50017	CA

General Provider Information

NPI Number	:	1326299801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES C KIM PHARMD

Provider Business Mailing Address
First Line	:	28973 BUENA VISTA CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-3020
Country	:	US
Telephone Number	:	661-513-3150
Fax Number	:

Provider Business Practice Location Address
First Line	:	23850 COPPERHILL DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-1701
Country	:	US
Telephone Number	:	661-775-3944
Fax Number	:

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

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	03/13/2019

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