Healthcare Provider Details

I. General information

NPI: 1144131970
Provider Name (Legal Business Name): JIN KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1985 ZONAL AVE
LOS ANGELES CA
90089-5305
US

IV. Provider business mailing address

16611 FLEUR BLVD
RIVERSIDE CA
92503-6915
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-1369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: