Provider Demographics
NPI:1578845384
Name:DUONG, KIM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:DUONG
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 1:1700 E VISTA CHINO
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-3511
Mailing Address - Country:US
Mailing Address - Phone:760-864-1516
Mailing Address - Fax:760-864-1568
Practice Address - Street 1:1700 E VISTA CHINO
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-3511
Practice Address - Country:US
Practice Address - Phone:760-864-1516
Practice Address - Fax:760-864-1568
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist