Active NPI
Jeongah Kim
- Pharmacist
- Olympia, WA
National Provider Identifier
1659133726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61476755
- Practice address
- 4280 Martin Way E
Olympia, WA 98516-5354 - Phone
- (360) 456-0709
- NPI assigned
- Jan 25, 2024
- 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 | PH61476755 | WA | Primary |
Addresses
Primary practice location
4280 Martin Way E
Olympia, WA 98516-5354
Mailing address
8533 Litt Dr SE Apt 205
Lacey, WA 98516-4630
Phone (402) 890-5675
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 |
|---|---|---|---|
| PH61476755 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706140800000",
"number": "1659133726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8533 LITT DR SE APT 205",
"city": "LACEY",
"state": "WA",
"postal_code": "985164630",
"telephone_number": "402-890-5675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4280 MARTIN WAY E",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985165354",
"telephone_number": "360-456-0709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JEONGAH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-01-25",
"last_updated": "2024-01-25",
"certification_date": "2024-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61476755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.