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General NPI Number Information
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NPI Number | 1083983761
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Entity Type | Individual
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Provider Name | CHARLES CHANG YOUNG KOH
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Gender | Male
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Dates
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Enumeration Date | 12/24/2011
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Last Update Date | 12/24/2011
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Provider Practice Location Address
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Address Line | 475 HIDDEN VALLEY PKWY
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City | NORCO
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State | CA
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Zip | 92860-3972
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Country | US
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Telephone | 951-280-1270
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Fax | 951-280-1276
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Provider Business Mailing Address
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Address Line | 19522 CLEVELAND BAY LN
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City | YORBA LINDA
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State | CA
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Zip | 92886-7923
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Country | US
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Telephone | 714-322-2138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 66449
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License Number State | CA
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