Provider Demographics
NPI:1023198082
Name:KIM, YUNG JA (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:YUNG
Middle Name:JA
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 MORRIS PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3621
Mailing Address - Country:US
Mailing Address - Phone:718-823-3443
Mailing Address - Fax:718-794-0925
Practice Address - Street 1:700 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3621
Practice Address - Country:US
Practice Address - Phone:718-823-3443
Practice Address - Fax:718-794-0925
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist