Provider Demographics
NPI:1699212092
Name:SIVATRANON, KEMIKA
Entity Type:Individual
Prefix:
First Name:KEMIKA
Middle Name:
Last Name:SIVATRANON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 SEPULVEDA BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1413
Mailing Address - Country:US
Mailing Address - Phone:818-837-2385
Mailing Address - Fax:818-837-2390
Practice Address - Street 1:11001 SEPULVEDA BLVD FL 2
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1413
Practice Address - Country:US
Practice Address - Phone:818-837-2385
Practice Address - Fax:818-837-2390
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41706183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist