Provider Demographics
NPI:1003153164
Name:NGO, YEN KIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:KIM
Last Name:NGO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207 LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-5545
Mailing Address - Country:US
Mailing Address - Phone:615-758-9830
Mailing Address - Fax:615-758-9820
Practice Address - Street 1:11207 LEBANON RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-5545
Practice Address - Country:US
Practice Address - Phone:615-758-9830
Practice Address - Fax:615-758-9820
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist