Provider Demographics
NPI:1568522522
Name:IM, SUNGHEE (PHARM D)
Entity Type:Individual
Prefix:
First Name:SUNGHEE
Middle Name:
Last Name:IM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 FITZWILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4574
Mailing Address - Country:US
Mailing Address - Phone:415-867-8824
Mailing Address - Fax:
Practice Address - Street 1:4364 FITZWILLIAM ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4574
Practice Address - Country:US
Practice Address - Phone:415-867-8824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist