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NPI Code Detail

MEDICARE: KIN KUEN SO

MEDICARE: KIN KUEN SO
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
1183500000XPharmacistRPH 52334CA

General Provider Information

NPI Number : 1457651408
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIN KUEN SO
Provider Business Mailing Address
First Line : 5021 LAGUNA BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5262
Country : US
Telephone Number : 916-691-3777
Fax Number : 916-691-3782
Provider Business Practice Location Address
First Line : 5021 LAGUNA BLVD
Second Line :
City : ELK GROVE
State : CA
Zip : 95758-5262
Country : US
Telephone Number : 916-691-3777
Fax Number : 916-691-3782
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2010
Last Update Date : 10/25/2010

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Directions to “ KIN KUEN SO ” Practice Location

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