Provider Demographics
NPI:1881079135
Name:KIM-YEUNG, SUSAN (PHARMD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KIM-YEUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HYONG SOOK
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:176 HACKENSACK ST UNIT 15
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4120 PALISADES CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-6801
Practice Address - Country:US
Practice Address - Phone:845-348-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35862183500000X
GARPH028311183500000X
NJNJDCATEMP-010358183500000X
NYI068575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist