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General NPI Number Information
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NPI Number | 1164947339
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Entity Type | Individual
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Provider Name | JAY Y KIM
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Gender | Male
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Dates
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Enumeration Date | 08/09/2017
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Last Update Date | 08/09/2017
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Provider Practice Location Address
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Address Line | 620 LAFAYETTE RD
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City | HAMPTON
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State | NH
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Zip | 03842-3348
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Country | US
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Telephone | 603-929-1258
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Fax |
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Provider Business Mailing Address
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Address Line | 875 ELM ST APT 503
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City | MANCHESTER
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State | NH
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Zip | 03101-2124
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Country | US
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Telephone | 214-537-9121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 4180
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License Number State | NH
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