Active NPI
Jenny Kim
- Pharmacist
- Los Angeles, CA
National Provider Identifier
1356067185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 86864
- Practice address
- 10889 Wellworth Ave
Los Angeles, CA 90024-4918 - Phone
- (310) 474-2152
- NPI assigned
- Oct 13, 2022
- 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 | 86864 | CA | Primary |
Addresses
Primary practice location
10889 Wellworth Ave
Los Angeles, CA 90024-4918
Mailing address
1246 Brockton Ave Apt 3
Los Angeles, CA 90025-1350
Phone (310) 408-7709
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86864 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665619200000",
"number": "1356067185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1246 BROCKTON AVE APT 3",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251350",
"telephone_number": "310-408-7709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10889 WELLWORTH AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900244918",
"telephone_number": "310-474-2152"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-10-13",
"last_updated": "2022-10-13",
"certification_date": "2022-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "86864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Oct 13, 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.