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NPI Code Detail

MEDICARE: VAN KIEU PHARMD

MEDICARE: VAN KIEU PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist79091CA

General Provider Information

NPI Number : 1144705963
Entity Type Code : Individual
Provider Name (Legal Business Name) : VAN KIEU PHARMD
Provider Business Mailing Address
First Line : 9771 CROSBY AVE
Second Line :
City : GARDEN GROVE
State : CA
Zip : 92844-1609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 24081 EL TORO RD
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-3103
Country : US
Telephone Number : 949-206-9632
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2018
Last Update Date : 09/27/2018

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