=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952058109
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUNG IL KIM PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2022
-----------------------------------------------------
Last Update Date | 07/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8141 8TH ST APT 9
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-614-1704
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8141 8TH ST APT 9
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-3065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-614-1704
-----------------------------------------------------
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 | 68418
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------