Provider Demographics
NPI:1659693927
Name:KIM, HYUNCHUNG (PHARMACIST)
Entity Type:Individual
Prefix:MRS
First Name:HYUNCHUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 SHAFTER AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1822
Mailing Address - Country:US
Mailing Address - Phone:516-741-4694
Mailing Address - Fax:
Practice Address - Street 1:1 GUSSACK PLZ
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-3256
Practice Address - Country:US
Practice Address - Phone:516-829-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist