Provider Demographics
NPI:1619378353
Name:KIM, HYUN KYUNG (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:KYUNG
Last Name:KIM
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 1:1101 S SANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-9047
Mailing Address - Country:US
Mailing Address - Phone:951-929-0379
Mailing Address - Fax:951-929-0744
Practice Address - Street 1:1101 S SANDERSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-9047
Practice Address - Country:US
Practice Address - Phone:951-929-0379
Practice Address - Fax:951-929-0744
Is Sole Proprietor?:No
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA71389OtherCALIFORNIA PHAMACIST LICENSE NUMBER