Provider Demographics
NPI:1619458213
Name:VO, KIM LONG THI (PHARMACIST)
Entity Type:Individual
Prefix:DR
First Name:KIM LONG
Middle Name:THI
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13367 SUNSHINE PATH
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4703
Mailing Address - Country:US
Mailing Address - Phone:619-203-1098
Mailing Address - Fax:
Practice Address - Street 1:3177 OCEAN VIEW BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-1432
Practice Address - Country:US
Practice Address - Phone:619-231-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty