Provider Demographics
NPI:1316498249
Name:KIM, SOHYUN
Entity type:Individual
Prefix:MRS
First Name:SOHYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 S VIRGIL AVE
Mailing Address - Street 2:APT 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1400
Mailing Address - Country:US
Mailing Address - Phone:213-440-5252
Mailing Address - Fax:
Practice Address - Street 1:3030 W OLYMPIC BLVD
Practice Address - Street 2:#118
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-6501
Practice Address - Country:US
Practice Address - Phone:213-389-3030
Practice Address - Fax:213-739-2020
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-15
Last Update Date:2016-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68948183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric