Healthcare Provider Details

I. General information

NPI: 1518038215
Provider Name (Legal Business Name): KOAM PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43380
License Number StateCA

VIII. Authorized Official

Name: KWANG KIM
Title or Position: OWNER / PHARMACIST
Credential: RPH
Phone: 562-402-3636