Healthcare Provider Details

I. General information

NPI: 1306935390
Provider Name (Legal Business Name): KEVIN YUJI OHARA PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 W SUNSET BLVD
LOS ANGELES CA
90027-5969
US

IV. Provider business mailing address

1579 NEW YORK DR
ALTADENA CA
91001-3217
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-8308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number42107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: