Provider Demographics
NPI:1508169525
Name:KIM, SARA JIHAE (PHARMACIST)
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:JIHAE
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S JOYCE ST APT 1128
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5124
Mailing Address - Country:US
Mailing Address - Phone:571-213-2856
Mailing Address - Fax:
Practice Address - Street 1:3614 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1908
Practice Address - Country:US
Practice Address - Phone:703-379-6030
Practice Address - Fax:703-379-0414
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist