Active NPI
Richard Jaeyoung Kim
- Pharmacist
- Anaheim, CA
National Provider Identifier
1912544149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 81170
- Practice address
- 3460 E la Palma Ave
Anaheim, CA 92806-2020 - Phone
- (714) 644-7180
- NPI assigned
- Dec 6, 2019
- Sex
- Male
- 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 | 81170 | CA | Primary |
Addresses
Primary practice location
3460 E la Palma Ave
Anaheim, CA 92806-2020
Mailing address
2731 Brierhaven Dr
La Crescenta, CA 91214-1403
Phone (818) 484-0803
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 |
|---|---|---|---|
| 81170 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1575590400000",
"number": "1912544149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2731 BRIERHAVEN DR",
"city": "LA CRESCENTA",
"state": "CA",
"postal_code": "912141403",
"telephone_number": "818-484-0803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3460 E LA PALMA AVE",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928062020",
"telephone_number": "714-644-7180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "RICHARD",
"middle_name": "JAEYOUNG",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-06",
"last_updated": "2019-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "81170",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.