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NPI Code Detail

MEDICARE: CHRISTY KIM

MEDICARE: CHRISTY 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
1183500000XPharmacist68225CA

General Provider Information

NPI Number : 1538577689
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTY KIM
Provider Business Mailing Address
First Line : 31700 GRAPE ST
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-9785
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 31700 GRAPE ST
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-9785
Country : US
Telephone Number : 951-245-4329
Fax Number : 951-245-2851
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2014
Last Update Date : 07/31/2014

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Directions to “ CHRISTY KIM ” Practice Location

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