MEDICARE: MIN 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	48554	CA

General Provider Information

NPI Number	:	1679000640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIN KIM

Provider Business Mailing Address
First Line	:	1774 RED ROBIN PL
Second Line	:
City	:	NEWBURY PARK
State	:	CA
Zip	:	91320-6567
Country	:	US
Telephone Number	:	805-233-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 SANTA ROSA RD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-7056
Country	:	US
Telephone Number	:	805-484-8208
Fax Number	:	805-389-0713

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

Provider Enumeration Date	:	05/21/2017
Last Update Date	:	05/21/2017

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Directions to “ MIN KIM ” Practice Location

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