Healthcare Provider Details

I. General information

NPI: 1427311653
Provider Name (Legal Business Name): KIM ANN HOANG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PARKMOOR AVE
SAN JOSE CA
95126-3797
US

IV. Provider business mailing address

1400 PARKMOOR AVE
SAN JOSE CA
95126-3797
US

V. Phone/Fax

Practice location:
  • Phone: 408-793-2752
  • Fax: 408-793-2751
Mailing address:
  • Phone: 408-793-2752
  • Fax: 408-793-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH44198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: