Healthcare Provider Details

I. General information

NPI: 1790152114
Provider Name (Legal Business Name): JOANNA J KIM PHARMACIST INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1750 PACIFIC AVE
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JOANNA J KIM
Title or Position: AUTHORIZED OFFICAL
Credential:
Phone: 562-599-5292