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NPI Code Detail

MEDICARE: JINA ANN KIM PHARM D.

MEDICARE: JINA ANN KIM PHARM D.
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
1183500000XPharmacist055972NY

General Provider Information

NPI Number : 1386925113
Entity Type Code : Individual
Provider Name (Legal Business Name) : JINA ANN KIM PHARM D.
Provider Business Mailing Address
First Line : 13910 28TH RD APT 4E
Second Line :
City : FLUSHING
State : NY
Zip : 11354-1808
Country : US
Telephone Number : 347-610-5733
Fax Number :
Provider Business Practice Location Address
First Line : 2125 BROADWAY
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11106-4532
Country : US
Telephone Number : 718-932-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2011
Last Update Date : 09/07/2011

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