Provider Demographics
NPI:1598328148
Name:WHITE, KEVIN CHIAHUNG (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHIAHUNG
Last Name:WHITE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 CRUDEN BAY WAY
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3081
Mailing Address - Country:US
Mailing Address - Phone:714-864-6786
Mailing Address - Fax:
Practice Address - Street 1:268 RESERVATION RD
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3178
Practice Address - Country:US
Practice Address - Phone:831-384-1605
Practice Address - Fax:831-384-9662
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist