MEDICARE: CLARA KIM

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	79778	CA

General Provider Information

NPI Number	:	1316401284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA KIM

Provider Business Mailing Address
First Line	:	2012 W 236TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-6052
Country	:	US
Telephone Number	:	310-741-0320
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 PACIFIC COAST HWY
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-5356
Country	:	US
Telephone Number	:	310-372-4345
Fax Number	:

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

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	01/24/2019

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Directions to “ CLARA KIM ” Practice Location

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