Provider Demographics
NPI:1093233728
Name:MIN, LIAH KYUNG (PHARMD)
Entity Type:Individual
Prefix:
First Name:LIAH
Middle Name:KYUNG
Last Name:MIN
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 1:4551 MIMOSA DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2016
Mailing Address - Country:US
Mailing Address - Phone:909-532-0019
Mailing Address - Fax:
Practice Address - Street 1:2121 N D ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3915
Practice Address - Country:US
Practice Address - Phone:909-693-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75450183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA75450OtherCA BOARD OF PHARMACY