MEDICARE: DR. HYUNSUK 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	RI03183100	NJ
2	183500000X	Pharmacist	PCT.0011564	CT
3	183500000X	Pharmacist	055322-1	NY

General Provider Information

NPI Number	:	1730327503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUNSUK KIM PHARM.D.

Provider Business Mailing Address
First Line	:	300 MAMARONECK AVE APT 304
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10605-6413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2506 FOREST HAVEN BLVD
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-6338
Country	:	US
Telephone Number	:	732-754-0432
Fax Number	:

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

Provider Enumeration Date	:	02/01/2009
Last Update Date	:	03/06/2011

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