Healthcare Provider Details

I. General information

NPI: 1538446653
Provider Name (Legal Business Name): SO-YEON KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 W MCDOWELL RD
PHOENIX AZ
85009-2096
US

IV. Provider business mailing address

4230 W MCDOWELL RD
PHOENIX AZ
85009-2096
US

V. Phone/Fax

Practice location:
  • Phone: 602-415-5733
  • Fax:
Mailing address:
  • Phone: 602-415-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS014600
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: