Provider Demographics
NPI:1912515164
Name:KIM, AILIN JENNIFER (PHARMD)
Entity Type:Individual
Prefix:
First Name:AILIN
Middle Name:JENNIFER
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 1:3123 FOOTHILL BLVD APT 7
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2633
Mailing Address - Country:US
Mailing Address - Phone:818-279-4736
Mailing Address - Fax:
Practice Address - Street 1:275 HOSPITAL PKWY STE 625
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1141
Practice Address - Country:US
Practice Address - Phone:408-363-4554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist