MEDICARE: KIM HEHN

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	183500000X	Pharmacist	35919	CA

General Provider Information

NPI Number	:	1427334218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM HEHN

Provider Business Mailing Address
First Line	:	6701 CARNELIAN STREET
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-1066
Country	:	US
Telephone Number	:	909-581-1157
Fax Number	:	909-581-1066

Provider Business Practice Location Address
First Line	:	6701 CARNELIAN ST
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-4556
Country	:	US
Telephone Number	:	909-581-1157
Fax Number	:	909-581-1066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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Directions to “ KIM HEHN ” Practice Location

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