Provider Demographics
NPI:1790152114
Name:JOANNA J KIM PHARMACIST INC
Entity Type:Organization
Organization Name:JOANNA J KIM PHARMACIST INC
Other - Org Name:GOLDEN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-599-5292
Mailing Address - Street 1:1750 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-1715
Mailing Address - Country:US
Mailing Address - Phone:562-599-5292
Mailing Address - Fax:562-599-1893
Practice Address - Street 1:1750 PACIFIC AVE STE A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1715
Practice Address - Country:US
Practice Address - Phone:562-599-5292
Practice Address - Fax:562-599-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1790152114Medicaid
CAPHY59057OtherPHARMACY PERMIT