Provider Demographics
NPI:1710395306
Name:KWONG, ANDREW MING YUEN (PHARM D)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MING YUEN
Last Name:KWONG
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 1:3133 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2703
Mailing Address - Country:US
Mailing Address - Phone:323-223-3228
Mailing Address - Fax:323-222-1825
Practice Address - Street 1:3133 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2703
Practice Address - Country:US
Practice Address - Phone:323-223-3228
Practice Address - Fax:323-222-1825
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist