MEDICARE: KIMBERLY THIEN HAN PHARM.D.

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
1	183500000X	Pharmacist	75633	CA

General Provider Information

NPI Number	:	1831633932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY THIEN HAN PHARM.D.

Provider Business Mailing Address
First Line	:	1252 S GRETTA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-5414
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1252 S GRETTA AVE
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91790-5414
Country	:	US
Telephone Number	:	626-560-1702
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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