Active NPI
Jan D Kim, PHARM.D.
- Pharmacist
- Corona, CA
National Provider Identifier
1114558517
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 78090
- Practice address
- 4485 Signature Dr
Corona, CA 92883-0633 - Phone
- (818) 425-6638
- NPI assigned
- Feb 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 78090 | CA | Primary |
Addresses
Primary practice location
4485 Signature Dr
Corona, CA 92883-0633
Mailing address
4485 Signature Dr
Corona, CA 92883-0633
Phone (818) 425-6638
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 |
|---|---|---|---|
| 78090 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1114558517",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4485 SIGNATURE DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928830633",
"telephone_number": "818-425-6638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4485 SIGNATURE DR",
"city": "CORONA",
"state": "CA",
"postal_code": "928830633",
"telephone_number": "818-425-6638"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JAN",
"middle_name": "D",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-04",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "78090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.