Provider Demographics
NPI:1407251028
Name:KHONG, JUDY MINH (RPH)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MINH
Last Name:KHONG
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 1:5164 1/2 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5953
Mailing Address - Country:US
Mailing Address - Phone:408-786-4448
Mailing Address - Fax:
Practice Address - Street 1:8440 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-4128
Practice Address - Country:US
Practice Address - Phone:818-739-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA71850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist