Healthcare Provider Details

I. General information

NPI: 1003464504
Provider Name (Legal Business Name): KIMMIE HANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date: 10/20/2023
Reactivation Date: 11/14/2023

III. Provider practice location address

777 S HARBOR BLVD
LA HABRA CA
90631
US

IV. Provider business mailing address

19424 SOLEDAD CANYON RD
CANYON COUNTRY CA
91351-2631
US

V. Phone/Fax

Practice location:
  • Phone: 800-746-7287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number88747
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: