Provider Demographics
NPI:1982159547
Name:KIM, HEO JUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:HEO JUNG
Middle Name:
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 1:1201 RIVER DR APT 23
Mailing Address - Street 2:
Mailing Address - City:COULEE DAM
Mailing Address - State:WA
Mailing Address - Zip Code:99116-1150
Mailing Address - Country:US
Mailing Address - Phone:503-515-2374
Mailing Address - Fax:
Practice Address - Street 1:101 GRAND COULEE HWY
Practice Address - Street 2:
Practice Address - City:GRAND COULEE
Practice Address - State:WA
Practice Address - Zip Code:99133-5014
Practice Address - Country:US
Practice Address - Phone:509-633-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60667548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist