Provider Demographics
NPI:1164742698
Name:CHAU, KIEN BA (RPH)
Entity Type:Individual
Prefix:
First Name:KIEN
Middle Name:BA
Last Name:CHAU
Suffix:
Gender:M
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:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-7728
Mailing Address - Country:US
Mailing Address - Phone:626-447-0211
Mailing Address - Fax:
Practice Address - Street 1:531 N GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3307
Practice Address - Country:US
Practice Address - Phone:818-241-9770
Practice Address - Fax:818-241-1965
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 44879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist