Provider Demographics
NPI:1154618320
Name:KIM, YOON C (RPH)
Entity type:Individual
Prefix:
First Name:YOON
Middle Name:C
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:BRIAN
Other - Middle Name:Y
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:10788 N GOLDEN EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93730-3590
Mailing Address - Country:US
Mailing Address - Phone:559-577-2054
Mailing Address - Fax:
Practice Address - Street 1:10788 N GOLDEN EAGLE DR
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-3590
Practice Address - Country:US
Practice Address - Phone:559-577-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist