Provider Demographics
NPI:1891166401
Name:KIM, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20439 VIA MEDICI
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4066
Mailing Address - Country:US
Mailing Address - Phone:818-480-1196
Mailing Address - Fax:818-592-3047
Practice Address - Street 1:21263 ERWIN ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3715
Practice Address - Country:US
Practice Address - Phone:818-592-2434
Practice Address - Fax:818-592-3047
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist