Healthcare Provider Details

I. General information

NPI: 1124636634
Provider Name (Legal Business Name): DA SOM KIM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 09/20/2023
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

2415 CHURCH AVE APT 709
BROOKLYN NY
11226-8444
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-1000
  • Fax: 212-562-1665
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051303155
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number067805
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: