Provider Demographics
NPI:1982053666
Name:KIM, THEODORA JIHYE (PHARMD)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:JIHYE
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 1:3500 W 6TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-5801
Mailing Address - Country:US
Mailing Address - Phone:213-739-3030
Mailing Address - Fax:213-739-3033
Practice Address - Street 1:3500 W 6TH ST STE 120
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-5801
Practice Address - Country:US
Practice Address - Phone:213-739-3030
Practice Address - Fax:213-739-3033
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist