MEDICARE: MS. SUNG JAE KIM PHARM

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	032562	NY

General Provider Information

NPI Number	:	1821247438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUNG JAE KIM PHARM

Provider Business Mailing Address
First Line	:	50 COLUMBUS AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2527
Country	:	US
Telephone Number	:	914-426-5229
Fax Number	:	718-992-2501

Provider Business Practice Location Address
First Line	:	50 COLUMBUS AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2527
Country	:	US
Telephone Number	:	914-426-5229
Fax Number	:	718-992-2501

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

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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