Active NPI
Bo Ram Kim, REGISTERED PHARMACIS
- Pharmacist
- Nipomo, CA
National Provider Identifier
1427695600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 81249
- Practice address
- 520 W Tefft St
Nipomo, CA 93444-8946 - Phone
- (805) 931-1860
- NPI assigned
- Dec 5, 2019
- 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 | 81249 | CA | Primary |
Addresses
Primary practice location
520 W Tefft St
Nipomo, CA 93444-8946
Mailing address
1992 Ridge Way GLN
Escondido, CA 92029-3149
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 |
|---|---|---|---|
| 81249 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vons Companies Inc | Past | Accepting new patients | |
| Vons Companies Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Vons Pharmacy #0286
- Community/Retail Pharmacy
- Santa Monica, CA
- NPI 1720879919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584662400000",
"number": "1427695600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1992 RIDGE WAY GLN",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920293149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 W TEFFT ST",
"city": "NIPOMO",
"state": "CA",
"postal_code": "934448946",
"telephone_number": "805-931-1860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "BO RAM",
"credential": "REGISTERED PHARMACIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-12-05",
"last_updated": "2020-03-20",
"certification_date": "2020-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81249",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nipomo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.