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NPI Code Detail

MEDICARE: ELISA KIM

MEDICARE: ELISA 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
1183500000XPharmacistRPH91035CA

General Provider Information

NPI Number : 1922972371
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISA KIM
Provider Business Mailing Address
First Line : 5010 STAGHORN DR
Second Line :
City : VALLEJO
State : CA
Zip : 94591-8580
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1123 S CALIFORNIA BLVD
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-4413
Country : US
Telephone Number : 925-933-8353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2025
Last Update Date : 09/30/2025

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Directions to “ ELISA KIM ” Practice Location

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