1356590228 NPI number — DR. JONG-MIN JONATHON KIM PHARMD

Table of content: DR. JONG-MIN JONATHON KIM PHARMD (NPI 1356590228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356590228 NPI number — DR. JONG-MIN JONATHON KIM PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
JONG-MIN
Provider Middle Name:
JONATHON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIM
Provider Other First Name:
JONATHON
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1356590228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14114 NORTHERN BLVD
Provider Second Line Business Mailing Address:
MY HOPE PHARMACY LLC
Provider Business Mailing Address City Name:
FLUSHING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11354-4239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-353-8202
Provider Business Mailing Address Fax Number:
718-353-8134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14114 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
MY HOPE PHARMACY LLC
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-4239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-353-8202
Provider Business Practice Location Address Fax Number:
718-353-8134
Provider Enumeration Date:
09/15/2008

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:  047691 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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