Provider Demographics
NPI:1194044230
Name:KIM, MEEHWA HEIDI
Entity Type:Individual
Prefix:
First Name:MEEHWA
Middle Name:HEIDI
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10811 ZELZAH AVE
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-4433
Mailing Address - Country:US
Mailing Address - Phone:818-360-8411
Mailing Address - Fax:818-831-3903
Practice Address - Street 1:10811 ZELZAH AVE
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4433
Practice Address - Country:US
Practice Address - Phone:818-360-8411
Practice Address - Fax:818-831-3903
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 43125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist