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NPI Code Detail

MEDICARE: TAE KIM

MEDICARE:   TAE  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
1183500000XPharmacist18031NV

General Provider Information

NPI Number : 1396112082
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAE KIM
Provider Business Mailing Address
First Line : 7100 ARROYO CROSSING PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4057
Country : US
Telephone Number : 702-260-6264
Fax Number :
Provider Business Practice Location Address
First Line : 7100 ARROYO CROSSING PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-4057
Country : US
Telephone Number : 702-260-6264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2015
Last Update Date : 08/28/2015

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Directions to “ TAE KIM ” Practice Location

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