Provider Demographics
NPI:1053637058
Name:KIM, SUNNA SUNHWA (PHARM D)
Entity type:Individual
Prefix:
First Name:SUNNA
Middle Name:SUNHWA
Last Name:KIM
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E 79TH ST
Mailing Address - Street 2:PHARMACY 2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0819
Mailing Address - Country:US
Mailing Address - Phone:212-879-1600
Mailing Address - Fax:212-879-4594
Practice Address - Street 1:211 E 79TH ST
Practice Address - Street 2:PHARMACY 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0819
Practice Address - Country:US
Practice Address - Phone:212-879-1600
Practice Address - Fax:212-879-4594
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY335232Medicare UPIN