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General NPI Number Information
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NPI Number | 1386160919
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Entity Type | Organization
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Legal Business Name | K-MOA HEALTHCARE, INC.
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12582 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-3507
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Country | US
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Telephone | 909-591-7429
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Fax | 909-902-9480
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Provider Business Mailing Address
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Address Line | 12582 CENTRAL AVE
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City | CHINO
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State | CA
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Zip | 91710-3507
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Country | US
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Telephone | 909-591-7429
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Fax |
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Authorized Official
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Title or Position | SECRETARY/PIC
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Name | DR. DIANE KIM
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Credential |
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Telephone | 909-591-7429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 55791
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License Number State | CA
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