Most Relevant Information
Provider Data
| NPI Number: | 1003378704 |
| Provider Name: | SANG H KIM |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 064957 |
Most Important Dates
| Enumeration Date: | 04/02/2019 |
| Last Updated: | 04/02/2019 |
Provider Practice Location
1110 ROUTE 112
PORT JEFFERSON STATION
NY
117763236
Practice Location Phone/Fax
| Phone: | 4017651500 |
| Fax: |
Provider Mailing Location
1110 ROUTE 112
PORT JEFFERSON STATION
NY
117763236
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |