Provider Demographics
NPI:1871648295
Name:ENG, KEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:
Last Name:ENG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:SIU
Other - Middle Name:KEUNG
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:17725 SILVERSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4221
Mailing Address - Country:US
Mailing Address - Phone:661-298-2512
Mailing Address - Fax:
Practice Address - Street 1:16830 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4247
Practice Address - Country:US
Practice Address - Phone:818-831-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH35351183500000X
TX27421183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist