Provider Demographics
NPI:1154509636
Name:KIM, HAN JOON DENNIS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HAN JOON
Middle Name:DENNIS
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 1:732 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1870
Mailing Address - Country:US
Mailing Address - Phone:760-839-7032
Mailing Address - Fax:
Practice Address - Street 1:732 N BROADWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1870
Practice Address - Country:US
Practice Address - Phone:760-839-7032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist