Provider Demographics
NPI:1033450994
Name:KIM, HYUNSOO (PHARMD)
Entity Type:Individual
Prefix:
First Name:HYUNSOO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2270 TREEMONT PL
Mailing Address - Street 2:APT#206
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7865
Mailing Address - Country:US
Mailing Address - Phone:956-467-3652
Mailing Address - Fax:
Practice Address - Street 1:25715 VAN LEUVEN ST APT 12
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2537
Practice Address - Country:US
Practice Address - Phone:956-467-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist