Basic Information
| Provider Information | |||||||||
| NPI: | 1912538836 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIM | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | EUNGI | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24809 40TH AVE APT 2 | ||||||||
| Address2: | |||||||||
| City: | LITTLE NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113631748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183093337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14246 ROOSEVELT AVE | ||||||||
| Address2: | |||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113546042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188880808 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2020 | ||||||||
| LastUpdateDate: | 01/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P0018X | 066456 | NY | Y | Pharmacy Service Providers | Pharmacist | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
No ID Information.