Provider Demographics
NPI:1912514563
Name:KIM, PEGGY Y (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:Y
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 1:4840 IRVIN BLVD. STE. 103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1962
Mailing Address - Country:US
Mailing Address - Phone:949-551-4343
Mailing Address - Fax:949-551-3078
Practice Address - Street 1:4840 IRVIN BLVD. STE. 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1962
Practice Address - Country:US
Practice Address - Phone:949-551-4343
Practice Address - Fax:949-551-3078
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist