Provider Demographics
NPI:1821510363
Name:KIM, SHI YOON (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHI YOON
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 NEW HAMPSHIRE AVE # A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2631
Mailing Address - Country:US
Mailing Address - Phone:301-244-4491
Mailing Address - Fax:301-244-4497
Practice Address - Street 1:11215 NEW HAMPSHIRE AVE # A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2631
Practice Address - Country:US
Practice Address - Phone:301-244-4491
Practice Address - Fax:301-244-4497
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist