Provider Demographics
NPI:1073642245
Name:KIM, JENNA SOOJUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:SOOJUNG
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SOOJUNG
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3875 ALTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8203
Mailing Address - Country:US
Mailing Address - Phone:714-722-4720
Mailing Address - Fax:949-474-2123
Practice Address - Street 1:3875 ALTON PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8203
Practice Address - Country:US
Practice Address - Phone:714-722-4720
Practice Address - Fax:949-474-2123
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist