Healthcare Provider Details

I. General information

NPI: 1003018524
Provider Name (Legal Business Name): KWANG JA KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16827 BELLFLOWER BLVD STE 101
BELLFLOWER CA
90706-5901
US

IV. Provider business mailing address

16827 BELLFLOWER BLVD STE 101
BELLFLOWER CA
90706-5901
US

V. Phone/Fax

Practice location:
  • Phone: 562-402-3636
  • Fax: 562-402-3676
Mailing address:
  • Phone: 562-402-3636
  • Fax: 562-402-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 30573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: