Provider Demographics
NPI:1134433279
Name:KIM, SUNG JIN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:SUNG JIN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 VISTA DEL VALLE RD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1876
Mailing Address - Country:US
Mailing Address - Phone:818-631-8304
Mailing Address - Fax:
Practice Address - Street 1:14727 RINALDI ST
Practice Address - Street 2:
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4189
Practice Address - Country:US
Practice Address - Phone:818-361-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist