JISU KIM (NPI# 1639717085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639717085 |
| Entity Type | Individual |
| Full Name | JISU KIM |
| Practice Address |
1055 Fremont Blvd Seaside CA 93955-5712 |
| Practice Telephone | 8313939231 |
| Mailing Telephone | 8313939231 |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2020-02-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | PH238383 | MA | Pharmacy Service Providers |
| Y | 183500000X | Pharmacist | RPH81253 | CA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568936763 | Jisu Kim | Dentist | Sandong-myeon Wonchon1 Gil 13-5, Sandong Branch Office of Gurye-gun Public Health Center, Gurye, JEOLLANAMDO 57602 | 2019-01-22 |
| 1275645871 | Jisu Kim | Internal Medicine | 1700 W Van Buren St, Suite 500, Chicago, IL 60612-3218 | 2006-08-31 |
| Street Address |
1055 FREMONT BLVD |
| City | SEASIDE |
| State | CA |
| Zip Code | 93955-5712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396750683 | Walgreen Co | Pharmacy | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2006-07-29 |
| 1467957449 | Eyob Ghebrehiwet Hagos | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2018-03-29 |
| 1497270813 | Jae Pil Yu | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2017-08-07 |
| 1316495435 | Tri Le | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955 | 2016-09-18 |
| 1952674244 | Eric Daniel Edwards | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2012-02-16 |
| 1437427945 | Timothy Wade Schick | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2011-12-12 |
| 1053689166 | Bridgette Sullivan | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2011-12-03 |
| 1649547969 | Susan Lynn Ehrreich-zankiewicz | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2011-12-01 |
| 1609143239 | Linda Ann Gould | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2011-11-28 |
| 1093082067 | Tina Crivello | Pharmacist | 1055 Fremont Blvd, Seaside, CA 93955-5712 | 2011-11-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912472614 | Benbenedic Montoya Aquino | Registered Nurse | 2095, 2095 Paralta Avenue, Seaside, CA 93955 | 2018-10-09 |
| 1316435803 | Teddy Yaw Akosa Agyapong | Pharmacist | 1055 Fremont Bld, Seaside, CA 93955 | 2018-04-30 |
| 1700381423 | Edmundo Fimbres Od Inc | Optometrist | 915 Hilby Ave Ste 1, Seaside, CA 93955 | 2018-03-26 |
| 1275948671 | Brian Peter Farley | Marriage & Family Therapist | 1187 Broadway Ave, Seaside, CA 93955 | 2014-06-24 |
| 1689953044 | Vertis Nathaniel Elmore IIi | Marriage & Family Therapist | 1069 Broadway Ave., Suite 201, Seaside, CA 93955 | 2011-08-16 |
| 1598944993 | Mary Theresa Panlilio | Dentist | 1249 Fremont Blvd, Suite B, Seaside, CA 93955 | 2007-11-01 |
| 1346459641 | Caroline Thomas Haskell | Social Worker | 100 Campus Center, Bldg 80, Seaside, CA 93955 | 2007-05-22 |
| 1811014715 | Anita Gor | Optometrist | 2040 California Ave. Target, Target Optical, Sand City, CA 93955 | 2007-03-23 |
| 1942333059 | Central Coast Pediatric Dental Group | Dentist | 1717 Fremont Blvd, Seaside, CA 93955 | 2007-03-14 |
| 1831209436 | Costco Wholesale Corporation | Pharmacy | 801 Tioga Ave, Sand City, CA 93955 | 2006-08-30 |
| Find all providers in zip 93955 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316435803 | Teddy Yaw Akosa Agyapong | Pharmacist | 1055 Fremont Bld, Seaside, CA 93955 | 2018-04-30 |
| 1699151902 | Joseph Alphonse Sutton | Pharmacist | 79380 Highway 202, Seaside, OR 97138 | 2015-08-10 |
| 1952735987 | Derk Penrod | Pharmacist | 401 S Roosevelt, Seaside, OR 97138 | 2013-08-27 |
| 1194166025 | Scott Allen Kafader | Pharmacist | 1150 N. Roosevelt Dr., Suite 104, Seaside, OR 97138 | 2013-07-08 |
| 1548552938 | Robert W Olson | Pharmacist | 313 S Rosevelt Drive, Seaside, OR 97138 | 2011-05-04 |
| 1750672341 | Jeffrey Chow | Pharmacist | 313 S Roosevelt Dr, Seaside, OR 97138-6743 | 2011-04-29 |
| 1558661884 | Marla Jean Nolan | Pharmacist | 8 Westminster Ct, Seaside, CA 93955-4027 | 2010-11-03 |
| 1215574397 | Ruby Thuy Dang | Pharmacist | 313 S Roosevelt Dr, Seaside, OR 97138-6743 | 2019-12-07 |
| 1346803707 | Emmalee Thornton | Pharmacist | 725 S Wahanna Rd, Seaside, OR 97138-7735 | 2019-04-20 |
| 1003372459 | Sonia Aujla | Pharmacist | 2040 California Ave, Seaside, CA 93955-3150 | 2019-02-11 |
| Find all providers in SEASIDE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.