NPIMap

Organization Active NPI

Little Tokyo Pharmacy, Inc.

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1174544134
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
LITTLE TOKYO PHARMACY, INC.
Practice address
402 E. 2ND St
Los Angeles, CA 90012
Phone
(213) 680-4011
Fax
(213) 680-0307
NPI assigned
Jul 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. William Wonkyu Kim, PH. DNPI 1538723218
Title
Pic/Owner
Phone
(213) 680-4011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

402 E. 2ND St
Los Angeles, CA 90012

Mailing address

402 E. 2ND St
Los Angeles, CA 90012
Phone (213) 680-4011

Other identifiers 2

IdentifierTypeStateIssuer
2114012OtherPK
PHA472820MedicaidCA

Other names 1

  • Little Tokyo Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220503002814 CA Part B Supplier - Mass Immunization (Roster Biller Only) 7113314576 Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory
Tax ID family
Little Tokyo Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1174544134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 E. 2ND ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90012",
            "telephone_number": "213-680-4011",
            "fax_number": "213-680-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 E. 2ND ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90012",
            "telephone_number": "213-680-4011",
            "fax_number": "213-680-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LITTLE TOKYO PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "WONKYU",
        "authorized_official_title_or_position": "PIC/OWNER",
        "authorized_official_telephone_number": "213-680-4011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH. D"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2114012",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA472820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Little Tokyo Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.