Provider Demographics
NPI:1740724616
Name:KONG, KA YING MICHELLE (PHARMD,)
Entity type:Individual
Prefix:
First Name:KA YING
Middle Name:MICHELLE
Last Name:KONG
Suffix:
Gender:F
Credentials:PHARMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2952 W SHORB ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1811
Mailing Address - Country:US
Mailing Address - Phone:626-376-2112
Mailing Address - Fax:
Practice Address - Street 1:2952 W SHORB ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1811
Practice Address - Country:US
Practice Address - Phone:626-376-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA75584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist