Provider Demographics
NPI:1356590228
Name:KIM, JONG-MIN JONATHON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JONG-MIN
Middle Name:JONATHON
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JONATHON
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:14114 NORTHERN BLVD
Mailing Address - Street 2:MY HOPE PHARMACY LLC
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4239
Mailing Address - Country:US
Mailing Address - Phone:718-353-8202
Mailing Address - Fax:718-353-8134
Practice Address - Street 1:14114 NORTHERN BLVD
Practice Address - Street 2:MY HOPE PHARMACY LLC
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4239
Practice Address - Country:US
Practice Address - Phone:718-353-8202
Practice Address - Fax:718-353-8134
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047691183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist