Provider Demographics
NPI:1649023169
Name:KIM, DAVID JUN (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JUN
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 1:3930 SILVER LAKE RD NE
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:MN
Mailing Address - Zip Code:55421-4370
Mailing Address - Country:US
Mailing Address - Phone:612-781-6405
Mailing Address - Fax:612-789-8778
Practice Address - Street 1:3930 SILVER LAKE RD NE
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:MN
Practice Address - Zip Code:55421-4370
Practice Address - Country:US
Practice Address - Phone:612-781-6405
Practice Address - Fax:612-789-8778
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN126283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist