John Jong Kim, RPH
Individual provider Active NPI Pharmacist · Dunkirk, MD
NPI 1578047684 · NPPES record last updated Sep 25, 2018
Key facts
- NPI
- 1578047684
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 25370 (MD)
- Practice address
- 10095 Ward Rd
Dunkirk, MD 20754-2731 - Phone
- (410) 257-0191
- NPI assigned
- Sep 25, 2018
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25370 | MD | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 25370 | MD | Yes |
Addresses
Primary practice location
10095 Ward Rd
Dunkirk, MD 20754-2731
Mailing address
10095 Ward Rd
Dunkirk, MD 20754-2731
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11378339250 | Medicaid | MD |
Other providers in Dunkirk, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.