Healthcare Provider Details

I. General information

NPI: 1922016989
Provider Name (Legal Business Name): DOCTORS HOSPITAL OF WEST COVINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S ORANGE AVE
WEST COVINA CA
91790-2614
US

IV. Provider business mailing address

725 S ORANGE AVE
WEST COVINA CA
91790-2614
US

V. Phone/Fax

Practice location:
  • Phone: 626-338-8481
  • Fax: 626-960-9178
Mailing address:
  • Phone: 626-338-8481
  • Fax: 626-960-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHSP36739
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberHSP36739
License Number StateCA

VIII. Authorized Official

Name: DR. PAUL KOO
Title or Position: PHARMACY DIRECTOR
Credential: PHARMD
Phone: 626-338-8481