MEDICARE: EDWARD SANG BIN KIM PHARMD

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	067588	NY

General Provider Information

NPI Number	:	1699369140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD SANG BIN KIM PHARMD

Provider Business Mailing Address
First Line	:	1 GUSSACK PLZ
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-3256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 E 188TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5406
Country	:	US
Telephone Number	:	718-367-2000
Fax Number	:

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

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	10/26/2023

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