Active NPI
Youngtae Kim, PHARMD, MBA
- Pharmacotherapy Pharmacist
- Walla Walla, WA
National Provider Identifier
1609374867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- PH60781611
- Practice address
- 401 W Poplar St
Walla Walla, WA 99362-2846 - Phone
- (503) 519-4302
- NPI assigned
- Jan 23, 2018
- Last updated
- Jan 23, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | PH60781611 | WA | Primary |
Addresses
Primary practice location
401 W Poplar St
Walla Walla, WA 99362-2846
Mailing address
187 NW Maria St Unit 1
College Place, WA 99324-2152
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH60781611 | Other | WA | PHAMACIST LICENSE |
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
- Master of Business Administration, Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH60781611 | WA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516665600000",
"number": "1609374867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "187 NW MARIA ST UNIT 1",
"city": "COLLEGE PLACE",
"state": "WA",
"postal_code": "993242152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 W POPLAR ST",
"city": "WALLA WALLA",
"state": "WA",
"postal_code": "993622846",
"telephone_number": "503-519-4302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "YOUNGTAE",
"credential": "PHARMD, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-01-23",
"last_updated": "2018-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "WA",
"license": "PH60781611",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHAMACIST LICENSE",
"identifier": "PH60781611",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Walla Walla, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.