Walnut Village Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

WALNUT VILLAGE PHARMACY INC

Practice address

4840 Irvine Blvd. Ste 103
Irvine, CA 92620-1962

Phone

(949) 551-4343

Fax

(949) 551-3078

NPI assigned

Dec 4, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Fred B Kim, PHARM.D.NPI 1356957963

Title

Owner, Pharmacist in Charge

Phone

(949) 551-4343

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• WALNUT VILLAGE PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fred B Kim, PHARM.D.

  • Pharmacist
  • Irvine, CA
  • NPI 1356957963
  NPD Authorized official
• Peggy Y Kim, PHARM.D.

  • Pharmacist
  • Irvine, CA
  • NPI 1912514563
  NPD

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1669540803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 IRVINE BLVD. STE 103",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926201962",
            "telephone_number": "949-551-4343",
            "fax_number": "949-551-3078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4840 IRVINE BLVD. STE 103",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926201962",
            "telephone_number": "949-551-4343",
            "fax_number": "949-551-3078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT VILLAGE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-28",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER, PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "949-551-4343",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARM.D."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2002056",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA508560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALNUT VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALNUT VILLAGE PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Austin A. Wall, D.D.S.
• Douglas Cecil Wallace, PHD
• Shawna T. Wallace, PT
• Walmart Inc.
• Joan Walmsley, M.A.,LCSW
• David Walsh, PSYD
• Katie Walsh
• Roger N Walsh, M.D., PH.D.
• Spencer Kyle Walters
• Caroline Anne Walton, PT, DPT

• Community/Retail Pharmacy in Irvine, CA
• Providers in Irvine, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.