Healthcare Provider Details

I. General information

NPI: 1972596062
Provider Name (Legal Business Name): KIM TOAN T DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10512 BOLSA AVE STE 104
WESTMINSTER CA
92683-6727
US

IV. Provider business mailing address

10512 BOLSA AVE
WESTMINSTER CA
92683-6727
US

V. Phone/Fax

Practice location:
  • Phone: 714-554-4121
  • Fax: 714-554-2150
Mailing address:
  • Phone: 714-554-4121
  • Fax: 714-554-2150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY34579
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM-TOAN THI DO
Title or Position: PHARMACIST OWNER IN CHARGE
Credential: PHARMACIST
Phone: 714-374-1383