Provider Demographics
NPI:1821328378
Name:KIM, MYONG SON
Entity Type:Individual
Prefix:MRS
First Name:MYONG
Middle Name:SON
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12405 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLNAD
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8032
Mailing Address - Country:US
Mailing Address - Phone:425-822-9202
Mailing Address - Fax:425-822-9407
Practice Address - Street 1:12405 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLNAD
Practice Address - State:WA
Practice Address - Zip Code:98033-8032
Practice Address - Country:US
Practice Address - Phone:425-822-9202
Practice Address - Fax:425-822-9407
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00058747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist