Healthcare Provider Details

I. General information

NPI: 1669744827
Provider Name (Legal Business Name): CAROLYN HONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN ENG

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20011 BOLLINGER RD
CUPERTINO CA
95014-4532
US

IV. Provider business mailing address

20011 BOLLINGER RD
CUPERTINO CA
95014-4532
US

V. Phone/Fax

Practice location:
  • Phone: 408-973-8402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: