=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356485304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUNWOO L KIM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2007
-----------------------------------------------------
Last Update Date | 11/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 W OLYMPIC BLVD SUITE 150
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-732-1911
-----------------------------------------------------
Fax | 323-732-6917
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3130 W OLYMPIC BLVD SUITE 150
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-732-1911
-----------------------------------------------------
Fax | 323-732-6917
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. KUNWOO L KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-732-1911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PHY50784
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------