Individual
BUMSOO KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
218 N MAIN ST, SEBASTOPOL, CA 95472-3436
(707) 829-3007
Mailing address
505 GARFIELD PARK AVE, SANTA ROSA, CA 95409-3723
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
77269
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
77269
BOARD OF PHARMACY
CA
Enumeration date
10/02/2017
Last updated
10/02/2017
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