Provider Demographics
NPI:1548688328
Name:KBBA INC
Entity type:Organization
Organization Name:KBBA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:213-617-8099
Mailing Address - Street 1:230 E VALLEY BLVD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-6510
Mailing Address - Country:US
Mailing Address - Phone:213-617-8099
Mailing Address - Fax:213-617-7241
Practice Address - Street 1:230 E VALLEY BLVD
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-6510
Practice Address - Country:US
Practice Address - Phone:213-617-8099
Practice Address - Fax:213-617-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-31
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy