Provider Demographics
NPI:1073744264
Name:KIM, MINAH (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MINAH
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3954
Mailing Address - Country:US
Mailing Address - Phone:626-795-5956
Mailing Address - Fax:626-795-4998
Practice Address - Street 1:55 E CALIFORNIA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3954
Practice Address - Country:US
Practice Address - Phone:626-795-5956
Practice Address - Fax:626-795-4998
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist