Provider Demographics
NPI:1801197090
Name:KIM, SUN B (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:SUN
Middle Name:B
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 183RD ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9169
Mailing Address - Country:US
Mailing Address - Phone:360-893-7929
Mailing Address - Fax:
Practice Address - Street 1:611 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5907
Practice Address - Country:US
Practice Address - Phone:253-841-1534
Practice Address - Fax:253-840-3744
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00014265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist