Healthcare Provider Details

I. General information

NPI: 1932124237
Provider Name (Legal Business Name): MR. KEVIN KYEHWAN KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. KYE-HWAN KIM

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

8293 VALENCIA CIR
SANDY UT
84093-1229
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax:
Mailing address:
  • Phone: 801-568-3240
  • Fax: 801-568-3240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number318199-1701
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: