Provider Demographics
NPI:1205110483
Name:KIM, SUN (PHARM D)
Entity type:Individual
Prefix:MISS
First Name:SUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
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 1:18296 COLLIER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-2754
Mailing Address - Country:US
Mailing Address - Phone:951-471-2132
Mailing Address - Fax:951-674-2359
Practice Address - Street 1:18296 COLLIER AVE
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-2754
Practice Address - Country:US
Practice Address - Phone:951-471-2132
Practice Address - Fax:951-674-2359
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist