Provider Demographics
NPI:1669499216
Name:KLP LLC
Entity Type:Organization
Organization Name:KLP LLC
Other - Org Name:DSK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:714-537-6619
Mailing Address - Street 1:9580 GARDEN GROVE BLVD
Mailing Address - Street 2:#108
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:714-537-1769
Practice Address - Street 1:9580 GARDEN GROVE BLVD
Practice Address - Street 2:#108
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1529
Practice Address - Country:US
Practice Address - Phone:714-537-6619
Practice Address - Fax:714-537-1769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669499216Medicaid
CA5180240001Medicare ID - Type Unspecified