Provider Demographics
NPI:1790071512
Name:DANG, KIMLIEN T (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMLIEN
Middle Name:T
Last Name:DANG
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 1:8848 CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5496
Mailing Address - Country:US
Mailing Address - Phone:714-797-0712
Mailing Address - Fax:
Practice Address - Street 1:1605 W 1ST ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3626
Practice Address - Country:US
Practice Address - Phone:714-486-3708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist