Provider Demographics
NPI:1730327503
Name:KIM, HYUNSUK (PHARMD)
Entity type:Individual
Prefix:DR
First Name:HYUNSUK
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:HYUN
Other - Middle Name:S
Other - Last Name:BYUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:300 MAMARONECK AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-6413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2506 FOREST HAVEN BLVD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-6338
Practice Address - Country:US
Practice Address - Phone:732-754-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-01
Last Update Date:2011-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI03183100183500000X
CTPCT.0011564183500000X
NY055322-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist