MEDICARE: JI HYE 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	62399	CA
2	1835N1003X	Nutrition Support Pharmacist	62399	CA
3	1835P1200X	Pharmacotherapy Pharmacist	62399	CA

General Provider Information

NPI Number	:	1740637008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI HYE KIM

Provider Business Mailing Address
First Line	:	4301 S FIGUEROA ST STE E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2671
Country	:	US
Telephone Number	:	323-234-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 S FIGUEROA ST STE E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2671
Country	:	US
Telephone Number	:	323-234-4343
Fax Number	:

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

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/17/2016

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Directions to “ JI HYE KIM ” Practice Location

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