Provider Demographics
NPI:1740506815
Name:KIM, NAYOUNG
Entity type:Individual
Prefix:MISS
First Name:NAYOUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 WILSHIRE BLVD
Mailing Address - Street 2:SUIT #200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-2354
Mailing Address - Country:US
Mailing Address - Phone:213-385-2135
Mailing Address - Fax:
Practice Address - Street 1:3545 WILSHIRE BLVD
Practice Address - Street 2:SUIT #200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-2354
Practice Address - Country:US
Practice Address - Phone:213-385-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH 95162183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician