Provider Demographics
NPI:1780916924
Name:KIM, STEVE (PHARM D)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17806 LASSEN ST
Mailing Address - Street 2:113
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4817
Mailing Address - Country:US
Mailing Address - Phone:213-268-0556
Mailing Address - Fax:
Practice Address - Street 1:17806 LASSEN ST
Practice Address - Street 2:113
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4817
Practice Address - Country:US
Practice Address - Phone:213-268-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist