MEDICARE: RUSSELL Y KIM PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	57011	CA

General Provider Information

NPI Number	:	1164582581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL Y KIM PHARMD

Provider Business Mailing Address
First Line	:	17709 PARKVALLE PL
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-8832
Country	:	US
Telephone Number	:	323-251-6326
Fax Number	:

Provider Business Practice Location Address
First Line	:	313 N FIGUEROA ST RM 701
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2602
Country	:	US
Telephone Number	:	213-240-7740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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Directions to “ RUSSELL Y KIM PHARMD” Practice Location

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