Provider Demographics
NPI:1326421348
Name:KIM, MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHLLE
Other - Middle Name:
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1200 GARDEN VIEW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 GARDEN VIEW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2477
Practice Address - Country:US
Practice Address - Phone:760-536-7682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA611621835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB9574529OtherDRIVERS LICENSE