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General NPI Number Information
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NPI Number | 1194460063
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Entity Type | Individual
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Provider Name | GRACE YAISOL KIM
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Gender | Female
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 266 S HARVARD BLVD STE 140
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City | LOS ANGELES
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State | CA
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Zip | 90004-4389
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Country | US
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Telephone | 213-384-8763
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Fax | 213-384-7521
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Provider Business Mailing Address
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Address Line | 281 N MAR VISTA AVE UNIT 2
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City | PASADENA
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State | CA
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Zip | 91106-1587
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Country | US
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Telephone |
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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 | 84160
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License Number State | CA
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