Active NPI
Moon Kim
- Pharmacist
- San Jose, CA
National Provider Identifier
1790112738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 55244
- Practice address
- 751 S Bascom Ave BLDG W
San Jose, CA 95128-2604 - Phone
- (408) 885-2300
- NPI assigned
- Oct 5, 2013
- 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 | 55244 | CA | Primary |
Addresses
Primary practice location
751 S Bascom Ave BLDG W
San Jose, CA 95128-2604
Mailing address
1660 Manton CT
Campbell, CA 95008-5123
Phone (408) 376-3683
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 |
|---|---|---|---|
| 55244 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380931200000",
"number": "1790112738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1660 MANTON CT",
"city": "CAMPBELL",
"state": "CA",
"postal_code": "950085123",
"telephone_number": "408-376-3683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 S BASCOM AVE BLDG W",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951282604",
"telephone_number": "408-885-2300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MOON",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-05",
"last_updated": "2013-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "55244",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.