MEDICARE: MR. SEUNG YOL 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	RPH40147	CA

General Provider Information

NPI Number	:	1487708111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEUNG YOL KIM

Provider Business Mailing Address
First Line	:	1818 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5807
Country	:	US
Telephone Number	:	323-731-8304
Fax Number	:	323-731-0158

Provider Business Practice Location Address
First Line	:	1818 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5807
Country	:	US
Telephone Number	:	323-731-8304
Fax Number	:	323-731-0158

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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