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General NPI Number Information
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NPI Number | 1568913770
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Entity Type | Individual
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Provider Name | MELANIE QUYNH-TIEN KIM PHARM. D.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 9800 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-4713
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Country | US
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Telephone | 213-800-8410
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Fax |
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Provider Business Mailing Address
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Address Line | 1109 1/2 S BRONSON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90019-3221
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Country | US
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Telephone | 404-384-4649
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | RPH028067
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH87795
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License Number State | CA
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