MEDICARE: JI-HYEUN 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	59285	CA

General Provider Information

NPI Number	:	1811265820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JI-HYEUN KIM

Provider Business Mailing Address
First Line	:	3460 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2801
Country	:	US
Telephone Number	:	408-261-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	3460 EL CAMINO REAL
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-2809
Country	:	US
Telephone Number	:	408-261-1047
Fax Number	:

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	07/13/2022

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Directions to “ JI-HYEUN KIM ” Practice Location

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