Provider Demographics
NPI:1578863528
Name:KIM, GRACE HYOSUN (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:HYOSUN
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3145 S ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6251
Mailing Address - Country:US
Mailing Address - Phone:773-247-3394
Mailing Address - Fax:773-247-4159
Practice Address - Street 1:3145 S ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6251
Practice Address - Country:US
Practice Address - Phone:773-247-3394
Practice Address - Fax:773-247-4159
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILIL051.293402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist