Active NPI
Man Kim
- Pharmacist
- Lakewood, CA
National Provider Identifier
1821411521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 50704
- Practice address
- 20137 Pioneer Blvd
Lakewood, CA 90715-1051 - Phone
- (562) 924-1210
- Fax
- (562) 924-3430
- NPI assigned
- Jan 31, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 50704 | CA | Primary |
Addresses
Primary practice location
20137 Pioneer Blvd
Lakewood, CA 90715-1051
Mailing address
20137 Pioneer Blvd
Lakewood, CA 90715-1051
Phone (562) 924-1210
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 |
|---|---|---|---|
| 50704 | CA | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ralphs Grocery Company | Past | Accepting new patients | |
| Ralphs Grocery Company | Past | Accepting new patients |
Organizations & group practices 2
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": "1391126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391126400000",
"number": "1821411521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20137 PIONEER BLVD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907151051",
"telephone_number": "562-924-1210",
"fax_number": "562-924-3430"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20137 PIONEER BLVD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907151051",
"telephone_number": "562-924-1210",
"fax_number": "562-924-3430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "MAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-31",
"last_updated": "2014-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "50704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.