Healthcare Provider Details

I. General information

NPI: 1881521797
Provider Name (Legal Business Name): AGNES RAN KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19191 N KELSEY ST
MONROE WA
98272-1459
US

IV. Provider business mailing address

1118 7TH AVE NW
ISSAQUAH WA
98027-2749
US

V. Phone/Fax

Practice location:
  • Phone: 360-365-4036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRM.PH.61580904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: