Provider Demographics
NPI:1093070062
Name:KWAN, KIMBERLY WAI KEI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WAI KEI
Last Name:KWAN
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 1:15725 WHITTIER BLVD
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2347
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-464-5144
Practice Address - Street 1:15725 WHITTIER BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2347
Practice Address - Country:US
Practice Address - Phone:562-698-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist