Provider Demographics
NPI:1649726803
Name:KLINE, NGOC DUNG (RPH)
Entity type:Individual
Prefix:
First Name:NGOC
Middle Name:DUNG
Last Name:KLINE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38610 DESERT MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-0606
Mailing Address - Country:US
Mailing Address - Phone:312-560-9964
Mailing Address - Fax:
Practice Address - Street 1:38610 DESERT MIRAGE DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-0606
Practice Address - Country:US
Practice Address - Phone:312-560-9964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73987183500000X
IL051299169183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist