Healthcare Provider Details

I. General information

NPI: 1174544134
Provider Name (Legal Business Name): LITTLE TOKYO PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E. 2ND ST
LOS ANGELES CA
90012
US

IV. Provider business mailing address

402 E. 2ND ST
LOS ANGELES CA
90012
US

V. Phone/Fax

Practice location:
  • Phone: 213-680-4011
  • Fax: 213-680-0307
Mailing address:
  • Phone: 213-680-4011
  • Fax: 213-680-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. WILLIAM WONKYU KIM
Title or Position: PIC/OWNER
Credential: PH. D
Phone: 213-680-4011