Provider Demographics
NPI:1609124932
Name:KIM, SUNG (PHARMD, PA-C)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28821 CROWN VALLEY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-831-2011
Mailing Address - Fax:949-831-9644
Practice Address - Street 1:7525 EADS AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4806
Practice Address - Country:US
Practice Address - Phone:858-551-8698
Practice Address - Fax:858-551-8198
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58333183500000X
CA54579363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical