Provider Demographics
NPI:1447639554
Name:KIM, JI SUN (PHARMD)
Entity type:Individual
Prefix:
First Name:JI
Middle Name:SUN
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 W GLENDON WAY APT 20
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3194
Mailing Address - Country:US
Mailing Address - Phone:424-235-4546
Mailing Address - Fax:
Practice Address - Street 1:1100 W GLENDON WAY APT 20
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-3194
Practice Address - Country:US
Practice Address - Phone:424-235-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist