Provider Demographics
NPI:1588290738
Name:KIM, SCOTT H (PHARMD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:H
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 1:8887 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1249
Mailing Address - Country:US
Mailing Address - Phone:714-539-6631
Mailing Address - Fax:714-539-6660
Practice Address - Street 1:8887 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1249
Practice Address - Country:US
Practice Address - Phone:714-539-6631
Practice Address - Fax:714-539-6630
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist