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General NPI Number Information
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NPI Number | 1902189152
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Entity Type | Individual
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Provider Name | SOO MI KIM PHARM D
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 09/23/2011
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Provider Practice Location Address
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Address Line | 7155 VAN NUYS BLVD
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City | VAN NUYS
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State | CA
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Zip | 91405-3006
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Country | US
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Telephone | 818-989-4281
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Fax |
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Provider Business Mailing Address
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Address Line | 14926 ADDISON ST
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1335
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Country | US
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Telephone | 818-388-4124
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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 | 53955
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License Number State | CA
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