Active NPI
Ellen Hyerim Kim, PHARMD
- Pharmacist
- Brookhaven, GA
National Provider Identifier
1043956923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 029641
- Practice address
- 104 Town Blvd NE Ste A100
Brookhaven, GA 30319-3146 - Phone
- (770) 952-6601
- NPI assigned
- May 12, 2022
- Last updated
- May 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 029641 | GA | Primary |
Addresses
Primary practice location
104 Town Blvd NE Ste A100
Brookhaven, GA 30319-3146
Mailing address
104 Town Blvd NE Ste A100
Brookhaven, GA 30319-3146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029641 | GA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652313600000",
"number": "1043956923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 TOWN BLVD NE STE A100",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303193146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 TOWN BLVD NE STE A100",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303193146",
"telephone_number": "770-952-6601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ELLEN",
"middle_name": "HYERIM",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-12",
"last_updated": "2022-05-12",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "029641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.