Provider Demographics
NPI:1457823379
Name:HORNG, KENNETH PATRICK
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PATRICK
Last Name:HORNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48081 MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8298 LANDER AVE
Practice Address - Street 2:
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-8323
Practice Address - Country:US
Practice Address - Phone:209-226-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist