Healthcare Provider Details

I. General information

NPI: 1477489219
Provider Name (Legal Business Name): KMJW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 HAMNER AVE STE F
NORCO CA
92860-2965
US

IV. Provider business mailing address

1825 HAMNER AVE STE F
NORCO CA
92860-2965
US

V. Phone/Fax

Practice location:
  • Phone: 714-330-0272
  • Fax:
Mailing address:
  • Phone: 714-330-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WAFA MEKAIL
Title or Position: OWNER
Credential:
Phone: 714-330-0272