Provider Demographics
NPI:1750744603
Name:KIM, JI YEI (PHARMD)
Entity type:Individual
Prefix:
First Name:JI YEI
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CRESCENT VILLAGE CIR
Mailing Address - Street 2:APT 1388
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-3024
Mailing Address - Country:US
Mailing Address - Phone:213-703-6548
Mailing Address - Fax:
Practice Address - Street 1:1160 INDUSTRIAL RD
Practice Address - Street 2:SUITE 17
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4124
Practice Address - Country:US
Practice Address - Phone:800-780-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist