Healthcare Provider Details

I. General information

NPI: 1447528757
Provider Name (Legal Business Name): NIMITZ KITONGAN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S BROOKHURST ST
ANAHEIM CA
92804-4304
US

IV. Provider business mailing address

217 N DAHLIA DR
ANAHEIM CA
92801-5352
US

V. Phone/Fax

Practice location:
  • Phone: 714-772-0240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: