Provider Demographics
NPI:1992019657
Name:KIM, SOOMIN ROBERT (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SOOMIN
Middle Name:ROBERT
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 1:224 E RTE 4
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5119
Mailing Address - Country:US
Mailing Address - Phone:201-291-4190
Mailing Address - Fax:201-291-4192
Practice Address - Street 1:224 E RTE 4
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5119
Practice Address - Country:US
Practice Address - Phone:201-291-4190
Practice Address - Fax:201-291-4192
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03136700183500000X
MD17784183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist