MEDICARE: HEEKYUNG KIM RPH

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	PH60867022	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PH60867022	OTHER	WA	WASHINGTON STATE DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1891270450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEEKYUNG KIM RPH

Provider Business Mailing Address
First Line	:	14027 LAKE CITY WAY NE APT E607
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-3893
Country	:	US
Telephone Number	:	401-447-3969
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 DELRIDGE WAY SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-9810
Country	:	US
Telephone Number	:	206-763-2626
Fax Number	:

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

Provider Enumeration Date	:	09/30/2018
Last Update Date	:	09/30/2018

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