Provider Demographics
NPI:1326599853
Name:KIM, BOK HWAN
Entity Type:Individual
Prefix:
First Name:BOK HWAN
Middle Name:
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 1:13325 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1316
Mailing Address - Country:US
Mailing Address - Phone:562-926-5900
Mailing Address - Fax:562-926-5955
Practice Address - Street 1:13325 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1316
Practice Address - Country:US
Practice Address - Phone:562-926-5900
Practice Address - Fax:562-926-5955
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist