Provider Demographics
NPI:1578081287
Name:KIM, IN IL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:IN IL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:301 W HOBSONWAY
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1639
Mailing Address - Country:US
Mailing Address - Phone:760-922-3511
Mailing Address - Fax:760-922-4404
Practice Address - Street 1:301 W HOBSONWAY
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1639
Practice Address - Country:US
Practice Address - Phone:760-922-3511
Practice Address - Fax:760-922-4404
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76585183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty