Provider Demographics
NPI:1861885378
Name:KIM, DANIELLE AILEY (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:AILEY
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 WARNE ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-4062
Mailing Address - Country:US
Mailing Address - Phone:714-392-1004
Mailing Address - Fax:626-810-4470
Practice Address - Street 1:18339 COLIMA RD STE A
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2792
Practice Address - Country:US
Practice Address - Phone:626-810-1056
Practice Address - Fax:626-810-4470
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-08
Last Update Date:2015-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH27632183500000X
CARPH68995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist