Provider Demographics
NPI:1811218944
Name:KIM, KYONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:KYONG
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 S NEW HAMPSHIRE AVE
Mailing Address - Street 2:#108
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1849
Mailing Address - Country:US
Mailing Address - Phone:213-700-1608
Mailing Address - Fax:
Practice Address - Street 1:4410 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90270-2932
Practice Address - Country:US
Practice Address - Phone:323-771-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist