1356485304 NPI number — KUNWOO L KIM

Table of content: (NPI 1356485304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356485304 NPI number — KUNWOO L KIM

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
HARVARD PHARMACY
Provider Other Organization Name Type Code:
3
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:
1356485304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3130 W OLYMPIC BLVD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90006-2484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-732-1911
Provider Business Mailing Address Fax Number:
323-732-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3130 W OLYMPIC BLVD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-2484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-732-1911
Provider Business Practice Location Address Fax Number:
323-732-6917
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
KUNWOO
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
323-732-1911

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY50784 , 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)

  • Identifier: 05-45268 . This is a "NCPDP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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