Provider Demographics
NPI:1326111824
Name:KIM, MARTIN C
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LOMITA BLVD
Mailing Address - Street 2:102
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4909
Mailing Address - Country:US
Mailing Address - Phone:310-530-3010
Mailing Address - Fax:310-530-7618
Practice Address - Street 1:3400 LOMITA BLVD
Practice Address - Street 2:#102
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4909
Practice Address - Country:US
Practice Address - Phone:310-530-3010
Practice Address - Fax:310-530-7618
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38130OtherPHARMACIST