Provider Demographics
NPI:1659635019
Name:KIM, JUNG HA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:HA
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:HA
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:370 SW SEDGWICK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6432
Mailing Address - Country:US
Mailing Address - Phone:360-876-2698
Mailing Address - Fax:360-876-3678
Practice Address - Street 1:370 SW SEDGWICK RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6432
Practice Address - Country:US
Practice Address - Phone:360-876-2698
Practice Address - Fax:360-876-3678
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-30
Last Update Date:2012-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60151656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist