Organization
KWANGSUN C SHIN
Active
Organization
KWANGSUN C SHIN
Active
Other names
IMPERIAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KWANGSUN SHIN (OWNER & PIC)
(562) 902-5580
Entity
Organization
Contact information
Practice address
15074 IMPERIAL HWY, LA MIRADA, CA 90638-1301
(562) 902-5580
(562) 902-5589
Mailing address
15074 IMPERIAL HWY, LA MIRADA, CA 90638-1301
(562) 902-5580
(562) 902-5589
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46563
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2112601
PK
—
05
—
PHA465630
—
CA
Enumeration date
09/20/2006
Last updated
12/01/2016
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