Provider Demographics
NPI:1477714061
Name:LE, JADE NGAN-KIM (PHARMD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:NGAN-KIM
Last Name:LE
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 1:35325 DATE PALM DR STE 239
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7015
Mailing Address - Country:US
Mailing Address - Phone:760-969-6560
Mailing Address - Fax:760-328-2230
Practice Address - Street 1:35325 DATE PALM DR STE 239
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7015
Practice Address - Country:US
Practice Address - Phone:760-969-6560
Practice Address - Fax:760-328-2230
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60534OtherSTATE LICENSE