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NPI Code Detail

MEDICARE: DR. ALYSSA NAKYOUNG KIM R.PH

MEDICARE: DR. ALYSSA NAKYOUNG KIM R.PH
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
1183500000XPharmacistRP450917PA

General Provider Information

NPI Number : 1992250989
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALYSSA NAKYOUNG KIM R.PH
Provider Business Mailing Address
First Line : 1607 BRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-1360
Country : US
Telephone Number : 215-537-0169
Fax Number :
Provider Business Practice Location Address
First Line : 1607 BRIDGE ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-1360
Country : US
Telephone Number : 215-537-0169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2016
Last Update Date : 08/18/2016

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