Healthcare Provider Details

I. General information

NPI: 1861528051
Provider Name (Legal Business Name): SO-YOUNG KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 N GARFIELD AVE
PIERRE SD
57501-5507
US

IV. Provider business mailing address

819 E BROADWAY AVE APT B4
PIERRE SD
57501-2544
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-8830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5428
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: