Provider Demographics
NPI:1043662653
Name:KIM, SUNGIL (PHARM D)
Entity type:Individual
Prefix:MR
First Name:SUNGIL
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1623
Mailing Address - Country:US
Mailing Address - Phone:714-870-1444
Mailing Address - Fax:714-870-0933
Practice Address - Street 1:312 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1623
Practice Address - Country:US
Practice Address - Phone:714-870-1444
Practice Address - Fax:714-870-0933
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist