=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427160340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PETER KWOK-JEFF LUM PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 219 E OLIVE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93728-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-268-8258
-----------------------------------------------------
Fax | 559-268-1807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 219 E OLIVE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93728-3129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | PETER KIM KWOK
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 559-268-8258
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | PHY41280
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------