Provider Demographics
NPI:1902129703
Name:KIM, SEONG MI SEO (PHARM D)
Entity Type:Individual
Prefix:
First Name:SEONG MI
Middle Name:SEO
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 CORPORAL KENNEDY ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1426
Mailing Address - Country:US
Mailing Address - Phone:347-954-5393
Mailing Address - Fax:
Practice Address - Street 1:524 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2012
Practice Address - Country:US
Practice Address - Phone:718-230-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0010901183500000X
NJ28RI03098200183500000X
FLPS37538183500000X
NY055354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist