Provider Demographics
NPI:1083363923
Name:KIM, STEPHEN HWAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HWAN
Last Name:KIM
Suffix:
Gender:M
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 1:8831 PINE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:ATASCOCITA
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2314
Mailing Address - Country:US
Mailing Address - Phone:713-380-5945
Mailing Address - Fax:
Practice Address - Street 1:8831 PINE SHORES DR
Practice Address - Street 2:
Practice Address - City:ATASCOCITA
Practice Address - State:TX
Practice Address - Zip Code:77346-2314
Practice Address - Country:US
Practice Address - Phone:713-380-5945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist