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General NPI Number Information
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NPI Number | 1609124932
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Entity Type | Individual
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Provider Name | SUNG KIM PHARMD, PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/16/2012
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Last Update Date | 08/04/2017
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Provider Practice Location Address
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Address Line | 7525 EADS AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-4806
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Country | US
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Telephone | 858-551-8698
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Fax | 858-551-8198
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Provider Business Mailing Address
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Address Line | 28821 CROWN VALLEY PARKWAY
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677
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Country | US
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Telephone | 949-831-2011
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Fax | 949-831-9644
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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 | 58333
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 54579
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License Number State | CA
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