=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598139685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KHANH VO RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2015
-----------------------------------------------------
Last Update Date | 07/24/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S HARBOR BLVD STE B
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92704-1382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-760-4485
-----------------------------------------------------
Fax | 714-760-4449
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15951 MOUNT MITCHELL CIR
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-1310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-336-3743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 63636
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------