Provider Demographics
NPI:1447345236
Name:KAO, KENNETH C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:KAO
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 1:133 BONITA ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6416
Mailing Address - Country:US
Mailing Address - Phone:626-512-3168
Mailing Address - Fax:
Practice Address - Street 1:1515 W MERCED AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3403
Practice Address - Country:US
Practice Address - Phone:626-962-3685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57502OtherCA REGISTERED PHARMACIST