Provider Demographics
NPI:1053627901
Name:KIM, HAERAN (PHARAMCIST)
Entity Type:Individual
Prefix:MRS
First Name:HAERAN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARAMCIST
Other - Prefix:MRS
Other - First Name:HAERAN
Other - Middle Name:
Other - Last Name:JI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 N CANON DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4705
Mailing Address - Country:US
Mailing Address - Phone:310-273-3561
Mailing Address - Fax:310-273-6725
Practice Address - Street 1:300 N CANON DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4705
Practice Address - Country:US
Practice Address - Phone:310-273-3561
Practice Address - Fax:310-273-6725
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist