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NPI Code Detail

MEDICARE: JINTAE KIM

MEDICARE: JINTAE 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
1183500000XPharmacist46531CA

General Provider Information

NPI Number : 1831645357
Entity Type Code : Individual
Provider Name (Legal Business Name) : JINTAE KIM
Provider Business Mailing Address
First Line : 2655 SANTA ANA ST
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-2025
Country : US
Telephone Number : 323-582-5601
Fax Number : 323-582-6051
Provider Business Practice Location Address
First Line : 2655 SANTA ANA ST
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-2025
Country : US
Telephone Number : 323-582-5601
Fax Number : 323-582-6051
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2016
Last Update Date : 08/26/2016

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Directions to “ JINTAE KIM ” Practice Location

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