Provider Demographics
NPI:1922630110
Name:TRAN, KIMBERLY DUNG KIM (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DUNG KIM
Last Name:TRAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2225
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-0225
Mailing Address - Country:US
Mailing Address - Phone:714-548-4653
Mailing Address - Fax:
Practice Address - Street 1:9521 DALEN ST
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4847
Practice Address - Country:US
Practice Address - Phone:562-401-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist