Provider Demographics
NPI:1386926681
Name:KIM, JOHN YOUL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:YOUL
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:PO BOX 3807
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-3807
Mailing Address - Country:US
Mailing Address - Phone:714-520-5575
Mailing Address - Fax:714-520-5714
Practice Address - Street 1:946 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4305
Practice Address - Country:US
Practice Address - Phone:714-520-5575
Practice Address - Fax:714-520-5714
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38975183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist