Provider Demographics
NPI:1952058109
Name:KIM, YUNG IL (PHARMD)
Entity Type:Individual
Prefix:
First Name:YUNG
Middle Name:IL
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18943 VICKIE AVE APT 75
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6228
Mailing Address - Country:US
Mailing Address - Phone:714-614-1704
Mailing Address - Fax:
Practice Address - Street 1:18943 VICKIE AVE APT 75
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-6228
Practice Address - Country:US
Practice Address - Phone:714-614-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist