Provider Demographics
NPI:1518708411
Name:LE, KEVIN PHAM (PHARMD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:PHAM
Last Name:LE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6386 SETTING SUN DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6715
Mailing Address - Country:US
Mailing Address - Phone:714-369-7898
Mailing Address - Fax:
Practice Address - Street 1:400 TUCKER RD
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-2578
Practice Address - Country:US
Practice Address - Phone:661-825-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist