Provider Demographics
NPI:1760188114
Name:TONG, HANH KIM (DR)
Entity Type:Individual
Prefix:
First Name:HANH
Middle Name:KIM
Last Name:TONG
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9782 BEVERLY LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3837
Mailing Address - Country:US
Mailing Address - Phone:714-709-0370
Mailing Address - Fax:
Practice Address - Street 1:18436 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6706
Practice Address - Country:US
Practice Address - Phone:714-465-9410
Practice Address - Fax:714-274-9650
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist