Healthcare Provider Details

I. General information

NPI: 1114839636
Provider Name (Legal Business Name): ABIGAIL JEEYE HAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

16322 STONE GROVE LN
CERRITOS CA
90703-1947
US

V. Phone/Fax

Practice location:
  • Phone: 310-673-4660
  • Fax:
Mailing address:
  • Phone: 714-398-2320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number93217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: