Provider Demographics
NPI:1942025135
Name:KIM, KYUNYUN (RPH)
Entity type:Individual
Prefix:MR
First Name:KYUNYUN
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHAPIN RD, SUITE D8
Mailing Address - Street 2:
Mailing Address - City:PINE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058
Mailing Address - Country:US
Mailing Address - Phone:973-461-0113
Mailing Address - Fax:
Practice Address - Street 1:19 CHAPIN RD, SUITE D8
Practice Address - Street 2:
Practice Address - City:PINE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07058
Practice Address - Country:US
Practice Address - Phone:973-461-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068819183500000X
NJ28RI03553200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist