Provider Demographics
NPI:1669760161
Name:KIM, JUNG HOON (PHARMD)
Entity type:Individual
Prefix:
First Name:JUNG
Middle Name:HOON
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 1:2370 S AZUSA AVE
Mailing Address - Street 2:T2147
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-1511
Mailing Address - Country:US
Mailing Address - Phone:626-667-5401
Mailing Address - Fax:
Practice Address - Street 1:2370 S AZUSA AVE
Practice Address - Street 2:T2147
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-1511
Practice Address - Country:US
Practice Address - Phone:626-667-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist