MEDICARE: MAUREEN YOOJUNG KIM PHARMD

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	82849	CA

General Provider Information

NPI Number	:	1912510587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN YOOJUNG KIM PHARMD

Provider Business Mailing Address
First Line	:	1415 N BROADWAY
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-3904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 N BROADWAY
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-3904
Country	:	US
Telephone Number	:	949-305-0788
Fax Number	:

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

Provider Enumeration Date	:	08/25/2020
Last Update Date	:	09/26/2023

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