Basic Information
| Provider Information | |||||||||
| NPI: | 1215131644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | EUN YOUNG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17909 SEINE AVE | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907014225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624027415 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18102 PIONEER BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907013997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624023636 | ||||||||
| FaxNumber: | 5624023676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183700000X | 52516 | CA | Y | Pharmacy Service Providers | Pharmacy Technician |
No ID Information.