Provider Demographics
NPI:1396482840
Name:KIM, JONATHAN HYUNYOUNG (PHARMD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HYUNYOUNG
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9881 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7239
Mailing Address - Country:US
Mailing Address - Phone:954-554-5890
Mailing Address - Fax:
Practice Address - Street 1:9881 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7239
Practice Address - Country:US
Practice Address - Phone:954-554-5890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist