Provider Demographics
NPI:1932124237
Name:KIM, KEVIN KYEHWAN
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:KYEHWAN
Last Name:KIM
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:KYE-HWAN
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8293 VALENCIA CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1229
Mailing Address - Country:US
Mailing Address - Phone:801-568-3240
Mailing Address - Fax:801-568-3240
Practice Address - Street 1:500 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT318199-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist