Active NPI
Jin Ah Kim, PHARM.D.
- Pharmacist
- Ellensburg, WA
National Provider Identifier
1912264615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH 60550825
- Practice address
- 201 S Water St
Ellensburg, WA 98926-3675 - Phone
- (509) 962-0533
- NPI assigned
- Apr 19, 2012
- Last updated
- Sep 22, 2015
- 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 | PH 60550825 | WA | Primary |
Addresses
Primary practice location
201 S Water St
Ellensburg, WA 98926-3675
Mailing address
702 E 1St Ave
Apt #B-4
Ellensburg, WA 98926-3477
Phone (253) 670-3111
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH 60550825 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fred Meyer Stores Inc | Past | Accepting new patients | |
| Fred Meyer Stores Inc. | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Fred Meyer Pharmacy
- Community/Retail Pharmacy
- Ellensburg, WA
- NPI 1114963659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442880000000",
"number": "1912264615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "702 E 1ST AVE",
"address_2": "APT #B-4",
"city": "ELLENSBURG",
"state": "WA",
"postal_code": "989263477",
"telephone_number": "253-670-3111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S WATER ST",
"city": "ELLENSBURG",
"state": "WA",
"postal_code": "989263675",
"telephone_number": "509-962-0533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JIN",
"middle_name": "AH",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-04-19",
"last_updated": "2015-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH 60550825",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ellensburg, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.