Provider Demographics
NPI:1730561432
Name:KIM, SUN (RPH)
Entity type:Individual
Prefix:
First Name:SUN
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10137 WANDERING WAY ST
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-3019
Mailing Address - Country:US
Mailing Address - Phone:817-423-9569
Mailing Address - Fax:817-423-9582
Practice Address - Street 1:7400 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3904
Practice Address - Country:US
Practice Address - Phone:817-423-9569
Practice Address - Fax:817-423-9582
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist