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General NPI Number Information
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NPI Number | 1780769554
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Entity Type | Organization
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Legal Business Name | LEE S KIM
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 17742 BEACH BLVD SUITE 100
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6818
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Country | US
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Telephone | 714-848-4447
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Fax | 718-843-9149
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Provider Business Mailing Address
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Address Line | 17742 BEACH BLVD SUITE 100
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-6818
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEE SUNG KIM
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Credential | PHARMACIST
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Telephone | 714-848-4447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY37348
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License Number State | CA
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