Provider Demographics
NPI:1073171757
Name:KIM, YONGMIN (RPH)
Entity Type:Individual
Prefix:
First Name:YONGMIN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 S MOUNT VERNON AVE
Mailing Address - Street 2:E
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324
Mailing Address - Country:US
Mailing Address - Phone:909-222-4884
Mailing Address - Fax:909-222-4921
Practice Address - Street 1:1040 S MOUNT VERNON AVE
Practice Address - Street 2:E
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-222-4884
Practice Address - Fax:909-222-4921
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist