Healthcare Provider Details

I. General information

NPI: 1578632428
Provider Name (Legal Business Name): YEONHYANG KIM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 E EL CAMINO REAL STE 2
SUNNYVALE CA
94087
US

IV. Provider business mailing address

1082 E EL CAMINO REAL STE 2
SUNNYVALE CA
94087
US

V. Phone/Fax

Practice location:
  • Phone: 408-557-9100
  • Fax: 408-557-9148
Mailing address:
  • Phone: 408-557-9100
  • Fax: 408-557-9148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY43889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YEONHYANG KIM
Title or Position: PHARMACIST OWNER
Credential:
Phone: 408-557-9100