Provider Demographics
NPI:1972596062
Name:KIM TOAN T DO
Entity Type:Organization
Organization Name:KIM TOAN T DO
Other - Org Name:TANA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER IN CHARGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM-TOAN
Authorized Official - Middle Name:THI
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:714-374-1383
Mailing Address - Street 1:10512 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6727
Mailing Address - Country:US
Mailing Address - Phone:714-554-4121
Mailing Address - Fax:714-554-2150
Practice Address - Street 1:10512 BOLSA AVE
Practice Address - Street 2:STE 104
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6727
Practice Address - Country:US
Practice Address - Phone:714-554-4121
Practice Address - Fax:714-554-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY34579333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4354650001OtherMEDICARE ID
CAPHA345790Medicaid
4354650001Medicare NSC