Healthcare Provider Details

I. General information

NPI: 1578894598
Provider Name (Legal Business Name): KUNSOO KIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MERCER ST
SEATTLE WA
98109-4654
US

IV. Provider business mailing address

500 MERCER ST
SEATTLE WA
98109-4654
US

V. Phone/Fax

Practice location:
  • Phone: 206-352-4030
  • Fax: 206-352-4032
Mailing address:
  • Phone: 206-352-4030
  • Fax: 206-352-4032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH60277646
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: