1023046455 NPI number — JUNGSOO F KIM PHARMD

Table of content: JUNGSOO F KIM PHARMD (NPI 1023046455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023046455 NPI number — JUNGSOO F KIM PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JUNGSOO
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023046455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2825 CAPITOL AVENUE
Provider Second Line Business Mailing Address:
SUITE 3N108
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95816-6039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-887-4680
Provider Business Mailing Address Fax Number:
916-739-3208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 CAPITOL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 3N108
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95816-6039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-887-4680
Provider Business Practice Location Address Fax Number:
916-739-3208
Provider Enumeration Date:
06/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  26190 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835X0200X , with the licence number: 59558 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835X0200X , with the licence number: APH11113 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)