Provider Demographics
NPI:1306115134
Name:KIM, DAVID JAY HOON (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAY HOON
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 1:9680 W NORTHERN AVE
Mailing Address - Street 2:UNIT 1235
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-4639
Mailing Address - Country:US
Mailing Address - Phone:720-252-7773
Mailing Address - Fax:
Practice Address - Street 1:1515 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-1237
Practice Address - Country:US
Practice Address - Phone:623-935-3233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist