Provider Demographics
NPI:1023732831
Name:KIM, ANNIE AHHYUN (PHARMD)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:AHHYUN
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S ST ANDREWS PL APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4354
Mailing Address - Country:US
Mailing Address - Phone:213-200-4998
Mailing Address - Fax:
Practice Address - Street 1:3943 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2721
Practice Address - Country:US
Practice Address - Phone:818-549-2270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH86598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist