Provider Demographics
NPI:1396113965
Name:KIM, KRISTINE JIHAE (PHARMD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JIHAE
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 1:6219 142ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-4394
Mailing Address - Country:US
Mailing Address - Phone:425-890-1838
Mailing Address - Fax:
Practice Address - Street 1:4033 TALBOT RD S STE 260
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5767
Practice Address - Country:US
Practice Address - Phone:425-690-3533
Practice Address - Fax:425-690-9147
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-12
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60556194183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist