=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588321897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW HUI-DONG KIM PHARMD, MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2021
-----------------------------------------------------
Last Update Date | 03/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3756 SANTA ROSALIA DR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90008-3606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-295-5585
-----------------------------------------------------
Fax | 323-295-0140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1716 S SYCAMORE AVE
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90019-5337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-839-8900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS61927
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 84475
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------