Healthcare Provider Details

I. General information

NPI: 1366058794
Provider Name (Legal Business Name): JOANNA JONGAE KIM PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA J KIM PHARM.D

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 PACIFIC AVE # A
LONG BEACH CA
90813-1715
US

IV. Provider business mailing address

1750 PACIFIC AVE # A
LONG BEACH CA
90813-1715
US

V. Phone/Fax

Practice location:
  • Phone: 562-599-5292
  • Fax: 562-599-1893
Mailing address:
  • Phone: 562-599-5292
  • Fax: 562-599-1893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number82034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: