Provider Demographics
NPI:1457482150
Name:KIM, YOUNG SIK
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:SIK
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 1:8624 LOS COYOTES DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1026
Mailing Address - Country:US
Mailing Address - Phone:714-994-0177
Mailing Address - Fax:
Practice Address - Street 1:8624 LOS COYOTES DR
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1026
Practice Address - Country:US
Practice Address - Phone:714-994-0177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist