Provider Demographics
NPI:1225401037
Name:KIM, SUNGHEE PARK
Entity Type:Individual
Prefix:
First Name:SUNGHEE
Middle Name:PARK
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 1:7799 VALLEY VIEW ST
Mailing Address - Street 2:APT# G202
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1862
Mailing Address - Country:US
Mailing Address - Phone:951-312-8500
Mailing Address - Fax:
Practice Address - Street 1:7799 VALLEY VIEW ST
Practice Address - Street 2:APT# G202
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1862
Practice Address - Country:US
Practice Address - Phone:951-312-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist