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NPI Code Detail

MEDICARE: JENNIE KIM

MEDICARE: JENNIE 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
1183500000XPharmacist066315NY
2183500000XPharmacist28RI03324800NJ

General Provider Information

NPI Number : 1366090045
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIE KIM
Provider Business Mailing Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2381 FREDERICK DOUGLASS BLVD
Second Line :
City : NEW YORK
State : NY
Zip : 10027-1822
Country : US
Telephone Number : 212-749-6626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2019
Last Update Date : 06/08/2026

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Directions to “ JENNIE KIM ” Practice Location

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