Provider Demographics
NPI:1295019073
Name:KIM, SARAH SONG (PHARM D)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SONG
Last Name:KIM
Suffix:
Gender:F
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 1:2285 E SPRUCE AVE
Mailing Address - Street 2:#103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8019
Mailing Address - Country:US
Mailing Address - Phone:224-475-5769
Mailing Address - Fax:
Practice Address - Street 1:988 SIERRA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-1554
Practice Address - Country:US
Practice Address - Phone:559-897-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist