1396849345 NPI number — KIMPHARMACY JS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396849345 NPI number — KIMPHARMACY JS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMPHARMACY JS INC
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:
KIM 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:
1396849345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9828 GARDEN GROVE BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92844-1639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-534-4555
Provider Business Mailing Address Fax Number:
714-534-5127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9828 GARDEN GROVE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92844-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-534-4555
Provider Business Practice Location Address Fax Number:
714-534-5127
Provider Enumeration Date:
09/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SONG
Authorized Official First Name:
CHAEHOON
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-534-4555

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY55367 , 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: PHA323540 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2001145 . This is a "PK" identifier . This identifiers is of the category "OTHER".