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NPI Code Detail

MEDICARE: GRACE KIM

MEDICARE: GRACE 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
1183500000XPharmacist25839MD
2183500000XPharmacist065488NY

General Provider Information

NPI Number : 1841873205
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE KIM
Provider Business Mailing Address
First Line : 474 48TH AVE APT 34F
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11109-5624
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 150 50TH AVE
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101-6050
Country : US
Telephone Number : 718-729-3197
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2021
Last Update Date : 05/04/2021

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Directions to “ GRACE KIM ” Practice Location

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