Provider Demographics
NPI:1346041423
Name:KIM, EVELYN SUNGMIN (PHARMD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:SUNGMIN
Last Name:KIM
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-2126
Mailing Address - Country:US
Mailing Address - Phone:626-533-8902
Mailing Address - Fax:
Practice Address - Street 1:710 N ROSE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7520
Practice Address - Country:US
Practice Address - Phone:714-524-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90049183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist