Healthcare Provider Details

I. General information

NPI: 1528388162
Provider Name (Legal Business Name): KATHY JONGHI KIM RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

8030 DALE ST
BUENA PARK CA
90620-2251
US

IV. Provider business mailing address

5311 BRIDGEWOOD DR
LA PALMA CA
90623-1737
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-2396
  • Fax: 714-527-0212
Mailing address:
  • Phone: 714-522-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH40609
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: