Provider Demographics
NPI:1194377119
Name:KIM, JUNGEUN KATE
Entity Type:Individual
Prefix:
First Name:JUNGEUN
Middle Name:KATE
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 1:2121 143RD PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5946
Mailing Address - Country:US
Mailing Address - Phone:808-285-5324
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY STE 500
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5435
Practice Address - Country:US
Practice Address - Phone:425-514-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60865018183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist