MEDICARE: JANE JIHYEON KIM PHARM. D.

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	75826	CA

General Provider Information

NPI Number	:	1427591957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE JIHYEON KIM PHARM. D.

Provider Business Mailing Address
First Line	:	230 E BLITHEDALE AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2032
Country	:	US
Telephone Number	:	415-388-6354
Fax Number	:	415-388-0326

Provider Business Practice Location Address
First Line	:	230 E BLITHEDALE AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2032
Country	:	US
Telephone Number	:	415-388-6354
Fax Number	:	415-388-0326

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

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	04/11/2018

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