Provider Demographics
NPI:1447575907
Name:KIM, CHONG BOK (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CHONG
Middle Name:BOK
Last Name:KIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 KLONDIKE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4824
Mailing Address - Country:US
Mailing Address - Phone:718-698-6633
Mailing Address - Fax:
Practice Address - Street 1:778 KLONDIKE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4824
Practice Address - Country:US
Practice Address - Phone:718-698-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-28
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032560-1183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric