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NPI Code Detail

MEDICARE: KUNWOO L KIM

MEDICARE: KUNWOO L 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
13336C0003XCommunity/Retail PharmacyPHY50784CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
105-45268OTHERCANCPDP

General Provider Information

NPI Number : 1356485304
Entity Type Code : Organization
Provider Name (Legal Business Name) : KUNWOO L KIM
Provider Business Mailing Address
First Line : 3130 W OLYMPIC BLVD
Second Line : SUITE 150
City : LOS ANGELES
State : CA
Zip : 90006-2484
Country : US
Telephone Number : 323-732-1911
Fax Number : 323-732-6917
Provider Business Practice Location Address
First Line : 3130 W OLYMPIC BLVD
Second Line : SUITE 150
City : LOS ANGELES
State : CA
Zip : 90006-2484
Country : US
Telephone Number : 323-732-1911
Fax Number : 323-732-6917
Authorized Official
Title or Position : OWNER
Name : MR. KUNWOO L KIM
Credential :
Telephone Number : 323-732-1911
Provider Enumeration Date : 02/16/2007
Last Update Date : 11/03/2012

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Directions to “KUNWOO L KIM ” Practice Location

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