MEDICARE: CHOONG ANG PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHY48387	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5626342	OTHER		OTHER ID NUMBER
2	5626342	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1427275528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOONG ANG PHARMACY INC

Provider Business Mailing Address
First Line	:	2344 EL CAMINO REAL
Second Line	:	STE 114
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4072
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 EL CAMINO REAL
Second Line	:	STE 114
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4072
Country	:	US
Telephone Number	:	408-260-9911
Fax Number	:	408-260-9919

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BYOUNG HUN AN
Credential	:
Telephone Number	:	408-260-9911

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/12/2007

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Directions to “CHOONG ANG PHARMACY INC ” Practice Location

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