Provider Demographics
NPI:1740590330
Name:VU, KIM-THOA THI (RPH)
Entity Type:Individual
Prefix:
First Name:KIM-THOA
Middle Name:THI
Last Name:VU
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 EAGLE GLEN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883
Mailing Address - Country:US
Mailing Address - Phone:951-279-4480
Mailing Address - Fax:951-279-4479
Practice Address - Street 1:330 E LAMBERT RD STE 125
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4120
Practice Address - Country:US
Practice Address - Phone:143-647-1400
Practice Address - Fax:714-364-1448
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist