Active NPI
Eun Dam Kim, RPH
- Pharmacist
- Auburndale, NY
National Provider Identifier
1114641644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 069605
- Practice address
- 19301 Northern Blvd
Auburndale, NY 11358-2935 - Phone
- (347) 738-1255
- NPI assigned
- Sep 28, 2022
- Last updated
- Sep 28, 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 | 069605 | NY | Primary |
Addresses
Primary practice location
19301 Northern Blvd
Auburndale, NY 11358-2935
Mailing address
21923 67TH Ave Apt B
Oakland Gardens, NY 11364-2649
Phone (347) 738-1255
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 069605 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664323200000",
"number": "1114641644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21923 67TH AVE APT B",
"city": "OAKLAND GARDENS",
"state": "NY",
"postal_code": "113642649",
"telephone_number": "347-738-1255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19301 NORTHERN BLVD",
"city": "AUBURNDALE",
"state": "NY",
"postal_code": "113582935",
"telephone_number": "347-738-1255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "EUN DAM",
"name_prefix": "Ms.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-28",
"last_updated": "2022-09-28",
"certification_date": "2022-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "069605",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Auburndale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.