=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376228718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEJONG PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2023
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14901 41ST AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-749-0888
-----------------------------------------------------
Fax | 718-749-0890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14901 41ST AVE
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-1025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-749-0888
-----------------------------------------------------
Fax | 718-749-0890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HYE IN KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-986-1699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------