Provider Demographics
NPI:1497027486
Name:YIM, SOONYOUNG (RPH)
Entity type:Individual
Prefix:MRS
First Name:SOONYOUNG
Middle Name:
Last Name:YIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 W OLYMPIC BLVD
Mailing Address - Street 2:#102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2883
Mailing Address - Country:US
Mailing Address - Phone:213-381-7705
Mailing Address - Fax:213-381-7706
Practice Address - Street 1:2681 W OLYMPIC BLVD
Practice Address - Street 2:#102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2883
Practice Address - Country:US
Practice Address - Phone:213-381-7705
Practice Address - Fax:213-381-7706
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH45353183500000X
CA453531835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA469310Medicaid
CAPHA469310Medicaid
CA5302560001Medicare PIN