Healthcare Provider Details

I. General information

NPI: 1649715152
Provider Name (Legal Business Name): WILLIAM KOONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13701 BEACH BLVD STE A2
WESTMINSTER CA
92683-3201
US

IV. Provider business mailing address

13701 BEACH BLVD STE A2
WESTMINSTER CA
92683-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-373-0214
  • Fax: 714-373-0839
Mailing address:
  • Phone: 714-373-0214
  • Fax: 714-373-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: