MEDICARE: YONG JIN 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	033012	NY

General Provider Information

NPI Number	:	1376855379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONG JIN KIM

Provider Business Mailing Address
First Line	:	9 WALNUT DR
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-4716
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	894 6TH AVE
Second Line	:	MEZZANINE
City	:	NEW YORK
State	:	NY
Zip	:	10001-3508
Country	:	US
Telephone Number	:	212-695-4232
Fax Number	:	212-695-8658

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

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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Directions to “ YONG JIN KIM ” Practice Location

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