Healthcare Provider Details

I. General information

NPI: 1003794496
Provider Name (Legal Business Name): KIMVY ANGELA KHONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S MILLER ST
WENATCHEE WA
98801-3201
US

IV. Provider business mailing address

615 PIERE ST APT C309
WENATCHEE WA
98801-6160
US

V. Phone/Fax

Practice location:
  • Phone: 509-433-3365
  • Fax:
Mailing address:
  • Phone: 206-551-8706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberIR61058314
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: