Healthcare Provider Details

I. General information

NPI: 1073443628
Provider Name (Legal Business Name): LISA JAYI KIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

731 PALO VERDE AVE
PASADENA CA
91104-4813
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5176
  • Fax:
Mailing address:
  • Phone: 310-621-4678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number51188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: