Provider Demographics
NPI:1750651329
Name:MAI, VANG KIM (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:VANG
Middle Name:KIM
Last Name:MAI
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 1:621 I ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5110
Mailing Address - Country:US
Mailing Address - Phone:619-407-4057
Mailing Address - Fax:619-407-4089
Practice Address - Street 1:621 I ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5110
Practice Address - Country:US
Practice Address - Phone:619-407-4057
Practice Address - Fax:619-407-4089
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist