Provider Demographics
NPI:1366058794
Name:KIM, JOANNA JONGAE (PHARMD)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:JONGAE
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:J
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1750 PACIFIC AVE # A
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-1715
Mailing Address - Country:US
Mailing Address - Phone:562-599-5292
Mailing Address - Fax:562-599-1893
Practice Address - Street 1:1750 PACIFIC AVE # A
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1715
Practice Address - Country:US
Practice Address - Phone:562-599-5292
Practice Address - Fax:562-599-1893
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist