Provider Demographics
NPI:1811423148
Name:KIM, TAEHYUN (RPH)
Entity Type:Individual
Prefix:DR
First Name:TAEHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 PALO ALTO ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1203
Mailing Address - Country:US
Mailing Address - Phone:201-674-1012
Mailing Address - Fax:347-809-2728
Practice Address - Street 1:8655 PALO ALTO ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1203
Practice Address - Country:US
Practice Address - Phone:201-674-1012
Practice Address - Fax:347-809-2728
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist