Provider Demographics
NPI:1033704184
Name:KIM, GRACE H (PHARMD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:H
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 1:928 S WESTERN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1009
Mailing Address - Country:US
Mailing Address - Phone:213-382-0212
Mailing Address - Fax:213-382-0812
Practice Address - Street 1:928 S WESTERN AVE STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1009
Practice Address - Country:US
Practice Address - Phone:213-382-0212
Practice Address - Fax:213-382-0812
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH77164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist