Provider Demographics
NPI:1578615654
Name:CHIN, KWONG FATT (BS)
Entity Type:Individual
Prefix:MR
First Name:KWONG FATT
Middle Name:
Last Name:CHIN
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W VALLEY BL
Mailing Address - Street 2:#B
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3728
Mailing Address - Country:US
Mailing Address - Phone:626-281-2186
Mailing Address - Fax:626-281-3583
Practice Address - Street 1:415 W VALLEY BL
Practice Address - Street 2:#B
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3728
Practice Address - Country:US
Practice Address - Phone:626-281-2186
Practice Address - Fax:626-281-3583
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH47423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist