Healthcare Provider Details

I. General information

NPI: 1245898030
Provider Name (Legal Business Name): KYUNG KIM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 WILSHIRE BLVD STE 250
BEVERLY HILLS CA
90211-1848
US

IV. Provider business mailing address

540 S KENMORE AVE UNIT 306
LOS ANGELES CA
90020-2593
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-7602
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number65819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: