MEDICARE: MR. KWONG FATT CHIN BS

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	RPH47423	CA

General Provider Information

NPI Number	:	1578615654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KWONG FATT CHIN BS

Provider Business Mailing Address
First Line	:	415 W VALLEY BL
Second Line	:	#B
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-281-2186
Fax Number	:	626-281-3583

Provider Business Practice Location Address
First Line	:	415 W VALLEY BL
Second Line	:	#B
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3728
Country	:	US
Telephone Number	:	626-281-2186
Fax Number	:	626-281-3583

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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