Healthcare Provider Details

I. General information

NPI: 1922328558
Provider Name (Legal Business Name): MONA S KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2010
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 E ARROW HWY
AZUSA CA
91702-5800
US

IV. Provider business mailing address

915 E ARROW HWY
AZUSA CA
91702-5800
US

V. Phone/Fax

Practice location:
  • Phone: 626-332-7213
  • Fax: 626-331-7545
Mailing address:
  • Phone: 626-332-7213
  • Fax: 626-331-7545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number46533C
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: