Provider Demographics
NPI:1023046455
Name:KIM, JUNGSOO F (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUNGSOO
Middle Name:F
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 CAPITOL AVENUE
Mailing Address - Street 2:SUITE 3N108
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6039
Mailing Address - Country:US
Mailing Address - Phone:916-887-4680
Mailing Address - Fax:916-739-3208
Practice Address - Street 1:2825 CAPITOL AVENUE
Practice Address - Street 2:SUITE 3N108
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6039
Practice Address - Country:US
Practice Address - Phone:916-887-4680
Practice Address - Fax:916-739-3208
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA26190183500000X
CA595581835X0200X
CAAPH111131835X0200X
CA100721835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology