MEDICARE: VENICE 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	80546	CA

General Provider Information

NPI Number	:	1952959538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENICE KIM

Provider Business Mailing Address
First Line	:	11326 VISTA SORRENTO PKWY # L204
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-7645
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 W WASHINGTON AVE
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-2629
Country	:	US
Telephone Number	:	650-455-7678
Fax Number	:

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

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	08/28/2019

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Directions to “ VENICE KIM ” Practice Location

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