MEDICARE: MONA S 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	46533C	CA

General Provider Information

NPI Number	:	1922328558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA S KIM

Provider Business Mailing Address
First Line	:	531 N GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3307
Country	:	US
Telephone Number	:	818-241-9770
Fax Number	:	818-241-1965

Provider Business Practice Location Address
First Line	:	531 N GLENDALE AVE
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-3307
Country	:	US
Telephone Number	:	818-241-9770
Fax Number	:	818-241-1965

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

Provider Enumeration Date	:	06/05/2010
Last Update Date	:	06/05/2010

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Directions to “ MONA S KIM ” Practice Location

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