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NPI Code Detail

MEDICARE: JIYEON LEE KIM

MEDICARE: JIYEON LEE 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
1183500000XPharmacist18459-40WI

General Provider Information

NPI Number : 1629602172
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIYEON LEE KIM
Provider Business Mailing Address
First Line : 2727 W NORTH AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1549
Country : US
Telephone Number : 414-933-9150
Fax Number : 414-933-1620
Provider Business Practice Location Address
First Line : 2727 W NORTH AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53208-1549
Country : US
Telephone Number : 414-933-9150
Fax Number : 414-933-1620
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2020
Last Update Date : 02/24/2020

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