Provider Demographics
NPI:1356485304
Name:KUNWOO L KIM
Entity Type:Organization
Organization Name:KUNWOO L KIM
Other - Org Name:HARVARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KUNWOO
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-732-1911
Mailing Address - Street 1:3130 W OLYMPIC BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2484
Mailing Address - Country:US
Mailing Address - Phone:323-732-1911
Mailing Address - Fax:323-732-6917
Practice Address - Street 1:3130 W OLYMPIC BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2484
Practice Address - Country:US
Practice Address - Phone:323-732-1911
Practice Address - Fax:323-732-6917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY507843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-45268OtherNCPDP
CA6706720001Medicare NSC