Provider Demographics
NPI:1902800816
Name:YU KIM, KIL O
Entity Type:Individual
Prefix:MRS
First Name:KIL
Middle Name:O
Last Name:YU KIM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KIL
Other - Middle Name:OK
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:18339 A E COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2762
Mailing Address - Country:US
Mailing Address - Phone:626-810-1056
Mailing Address - Fax:626-810-4470
Practice Address - Street 1:18339 A E COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2762
Practice Address - Country:US
Practice Address - Phone:626-810-1056
Practice Address - Fax:626-810-4470
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41451183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA367020Medicaid
CA1136260001Medicare NSC