MEDICARE: GOLDEN SPRINGS PHARMACY INC.

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1326830118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN SPRINGS PHARMACY INC.

Provider Business Mailing Address
First Line	:	21010 GOLDEN SPRINGS DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-595-4003
Fax Number	:

Provider Business Practice Location Address
First Line	:	21010 GOLDEN SPRINGS DR
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-3831
Country	:	US
Telephone Number	:	909-595-4003
Fax Number	:

Authorized Official
Title or Position	:	CEO/CFO/DIR.
Name	:	HYUNG AH KIM
Credential	:
Telephone Number	:	949-751-7397

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	05/19/2025

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