MEDICARE: JOSHUA 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	PH1001268	MA

General Provider Information

NPI Number	:	1982416582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA KIM

Provider Business Mailing Address
First Line	:	2706 BEACON HILL DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5608
Country	:	US
Telephone Number	:	971-344-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 BEACON HILL DR
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-5608
Country	:	US
Telephone Number	:	971-344-9643
Fax Number	:

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

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/29/2025

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Directions to “ JOSHUA KIM ” Practice Location

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