Organization
KOAM PHARMACY LTC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KWANG JA KIM (CEO)
(562) 402-4922
Entity
Organization
Contact information
Practice address
18102 PIONEER BLVD STE 102, ARTESIA, CA 90701-4400
(562) 402-0400
Mailing address
18102 PIONEER BLVD STE 102, ARTESIA, CA 90701-4400
(562) 402-4922
(562) 402-0671
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033678248
—
CA
Enumeration date
03/18/2019
Last updated
11/27/2023
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