Provider Demographics
NPI:1821247438
Name:KIM, SUNG JAE (PHARM)
Entity Type:Individual
Prefix:MS
First Name:SUNG
Middle Name:JAE
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2527
Mailing Address - Country:US
Mailing Address - Phone:914-426-5229
Mailing Address - Fax:718-992-2501
Practice Address - Street 1:50 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2527
Practice Address - Country:US
Practice Address - Phone:914-426-5229
Practice Address - Fax:718-992-2501
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist