Provider Demographics
NPI:1740565159
Name:VO, KIM THANH (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:THANH
Last Name:VO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SECRET GDN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-4805
Mailing Address - Country:US
Mailing Address - Phone:949-387-8646
Mailing Address - Fax:
Practice Address - Street 1:36 SECRET GDN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-4805
Practice Address - Country:US
Practice Address - Phone:949-387-8646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist