Provider Demographics
NPI:1396170759
Name:HURLEY-KIM, KERI KATHLEEN (PHARMD, MPH)
Entity type:Individual
Prefix:DR
First Name:KERI
Middle Name:KATHLEEN
Last Name:HURLEY-KIM
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:KATHLEEN
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, MPH
Mailing Address - Street 1:802 W PELTASON DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92697-4625
Mailing Address - Country:US
Mailing Address - Phone:760-914-1011
Mailing Address - Fax:
Practice Address - Street 1:802 W PELTASON DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697-4625
Practice Address - Country:US
Practice Address - Phone:760-914-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108741835P0018X
CA69396183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA69396OtherCALIFORNIA BOARD OF PHARMACY
CA100351983OtherCALIFORNIA MEDI-CAL PAVE