Provider Demographics
NPI:1609463660
Name:KIM, JUN HO (PHARMD)
Entity type:Individual
Prefix:
First Name:JUN HO
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 AMESBURY CIR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-1178
Mailing Address - Country:US
Mailing Address - Phone:805-558-5524
Mailing Address - Fax:
Practice Address - Street 1:2681 W OLYMPIC BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2883
Practice Address - Country:US
Practice Address - Phone:213-381-7705
Practice Address - Fax:213-381-7706
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-24
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist