Provider Demographics
NPI:1245010990
Name:CHING, KELLY (PHARMD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CHING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MAN YI
Other - Last Name:CHING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLYKE
Mailing Address - Street 1:346 N VERMONT AVE APT 606
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3524
Mailing Address - Country:US
Mailing Address - Phone:415-990-8686
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:800-872-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist