Healthcare Provider Details

I. General information

NPI: 1912123548
Provider Name (Legal Business Name): SEYHA KEM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 ATLANTIC BLVD
MAYWOOD CA
90270-3119
US

IV. Provider business mailing address

4743 LAKEWOOD BLVD
LAKEWOOD CA
90712-3512
US

V. Phone/Fax

Practice location:
  • Phone: 323-771-4971
  • Fax: 323-771-3974
Mailing address:
  • Phone: 562-429-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH 58412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: