Active NPI
Jennifer Kim
- Pharmacist
- San Diego, CA
National Provider Identifier
1962236133
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 90050
- Practice address
- 3350 La Village Dr
San Diego, CA 92161-0001 - Phone
- (858) 552-8585
- NPI assigned
- Aug 29, 2024
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 3361075 | ID | |
| Pharmacist | 183500000X | 90050 | CA | Primary |
Addresses
Primary practice location
3350 La Village Dr
San Diego, CA 92161-0001
Mailing address
7045 Charmant Dr Apt 161
San Diego, CA 92122-4373
Phone (858) 877-8300
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 |
|---|---|---|---|
| 90050 | CA | MD | Marriage & Family Therapist |
| 3361075 | ID | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1962236133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7045 CHARMANT DR APT 161",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921224373",
"telephone_number": "858-877-8300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 LA VILLAGE DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921610001",
"telephone_number": "858-552-8585"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-29",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ID",
"license": "3361075",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "90050",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.