Healthcare Provider Details

I. General information

NPI: 1356255699
Provider Name (Legal Business Name): HYOUNGJU KIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 NORTHERN BLVD
JACKSON HEIGHTS NY
11372-1048
US

IV. Provider business mailing address

9418 34TH AVE APT 336
JACKSON HEIGHTS NY
11372-3843
US

V. Phone/Fax

Practice location:
  • Phone: 718-533-8434
  • Fax:
Mailing address:
  • Phone: 903-954-0249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: