1629022421 NPI number — MR. HAN SOO KIM RPH

Table of content: MR. HAN SOO KIM RPH (NPI 1629022421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629022421 NPI number — MR. HAN SOO KIM RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIM
Provider First Name:
HAN
Provider Middle Name:
SOO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629022421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1202 PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-6414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-886-8539
Provider Business Mailing Address Fax Number:
201-886-8539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 E 23RD ST
Provider Second Line Business Practice Location Address:
PHARMACY/119
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-686-7500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  031253-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)