Provider Demographics
NPI:1942521828
Name:KIM LEE, JIMIN
Entity Type:Individual
Prefix:
First Name:JIMIN
Middle Name:
Last Name:KIM LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JIMIN
Other - Middle Name:KIM
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:833 W TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3575
Mailing Address - Country:US
Mailing Address - Phone:215-736-9501
Mailing Address - Fax:215-428-3771
Practice Address - Street 1:833 W TRENTON AVE
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:PA
Practice Address - Zip Code:19067-3575
Practice Address - Country:US
Practice Address - Phone:215-736-9501
Practice Address - Fax:215-428-3771
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist