Provider Demographics
NPI:1386925113
Name:KIM, JINA ANN (PHARM D)
Entity type:Individual
Prefix:
First Name:JINA
Middle Name:ANN
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 28TH RD APT 4E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1808
Mailing Address - Country:US
Mailing Address - Phone:347-610-5733
Mailing Address - Fax:
Practice Address - Street 1:2125 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4532
Practice Address - Country:US
Practice Address - Phone:718-932-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist