Provider Demographics
NPI:1093379455
Name:DINH, KIM NGOCTHI (RPH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:NGOCTHI
Last Name:DINH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5353
Mailing Address - Country:US
Mailing Address - Phone:408-247-8700
Mailing Address - Fax:408-247-8214
Practice Address - Street 1:2700 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5353
Practice Address - Country:US
Practice Address - Phone:408-247-8700
Practice Address - Fax:408-247-8214
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54063183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1003859844OtherCVS HEALTH