Provider Demographics
NPI:1427430453
Name:KIM, DAE (PHARM D)
Entity type:Individual
Prefix:MR
First Name:DAE
Middle Name:
Last Name:KIM
Suffix:
Gender:M
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 1:4541 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2621
Mailing Address - Country:US
Mailing Address - Phone:949-854-8280
Mailing Address - Fax:949-854-7319
Practice Address - Street 1:4541 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2621
Practice Address - Country:US
Practice Address - Phone:949-854-8280
Practice Address - Fax:949-854-7319
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist