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General NPI Number Information
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NPI Number | 1679000640
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Entity Type | Individual
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Provider Name | MIN KIM
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Gender | Female
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Dates
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Enumeration Date | 05/21/2017
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Last Update Date | 05/21/2017
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Provider Practice Location Address
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Address Line | 5800 SANTA ROSA RD
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City | CAMARILLO
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State | CA
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Zip | 93012-7056
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Country | US
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Telephone | 805-484-8208
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Fax | 805-389-0713
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Provider Business Mailing Address
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Address Line | 1774 RED ROBIN PL
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6567
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Country | US
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Telephone | 805-233-0208
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 48554
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License Number State | CA
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