Provider Demographics
NPI:1871970665
Name:CHE, KIM (PHARMD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CHE
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 1:200 VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-5005
Mailing Address - Country:US
Mailing Address - Phone:415-859-3103
Mailing Address - Fax:415-878-7340
Practice Address - Street 1:200 VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5005
Practice Address - Country:US
Practice Address - Phone:415-859-3103
Practice Address - Fax:415-878-7340
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist