NPIMap

Individual provider Active NPI

Jung S Kim

  • Pharmacist
  • Los Angeles, CA
National Provider Identifier
1649223454
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
47648 Issued in CA
Practice address
3511 W Olympic Blvd
#102
Los Angeles, CA 90019-3563
Phone
(323) 731-0600
Fax
(323) 731-9787
NPI assigned
May 19, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 47648 CA Primary

Addresses

Primary practice location

3511 W Olympic Blvd
#102
Los Angeles, CA 90019-3563

Mailing address

3511 W Olympic Blvd
#102
Los Angeles, CA 90019-3563
Phone (323) 731-0600

Other identifiers 1

IdentifierTypeStateIssuer
5726360001MedicaidCA

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

LicenseStateTypeSpecialty
47648CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Wiltoh Pharmacy Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339545600000",
    "number": "1649223454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3511 W OLYMPIC BLVD",
            "address_2": "#102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900193563",
            "telephone_number": "323-731-0600",
            "fax_number": "323-731-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3511 W OLYMPIC BLVD",
            "address_2": "#102",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900193563",
            "telephone_number": "323-731-0600",
            "fax_number": "323-731-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNG",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2012-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "47648",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5726360001",
            "state": "CA"
        }
    ],
    "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 Jun 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.