MEDICARE: DR. JASON S KIM PHARM.D.

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	PST.020110	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PST.020110	OTHER	LA	LA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1205837945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON S KIM PHARM.D.

Provider Business Mailing Address
First Line	:	12724 SAGAMORE RD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209
Country	:	US
Telephone Number	:	858-220-2615
Fax Number	:

Provider Business Practice Location Address
First Line	:	12724 SAGAMORE RD
Second Line	:
City	:	LEAWOOD
State	:	KS
Zip	:	66209
Country	:	US
Telephone Number	:	858-220-2615
Fax Number	:

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	03/02/2017

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