Active NPI
Charles Chang Young Koh
- Pharmacist
- Norco, CA
National Provider Identifier
1083983761
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 66449
- Practice address
- 475 Hidden Valley Pkwy
Norco, CA 92860-3972 - Phone
- (951) 280-1270
- Fax
- (951) 280-1276
- NPI assigned
- Dec 24, 2011
- Last updated
- Dec 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 66449 | CA | Primary |
Addresses
Primary practice location
475 Hidden Valley Pkwy
Norco, CA 92860-3972
Mailing address
19522 Cleveland Bay LN
Yorba Linda, CA 92886-7923
Phone (714) 322-2138
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66449 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324684800000",
"number": "1083983761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19522 CLEVELAND BAY LN",
"city": "YORBA LINDA",
"state": "CA",
"postal_code": "928867923",
"telephone_number": "714-322-2138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "475 HIDDEN VALLEY PKWY",
"city": "NORCO",
"state": "CA",
"postal_code": "928603972",
"telephone_number": "951-280-1270",
"fax_number": "951-280-1276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOH",
"first_name": "CHARLES",
"middle_name": "CHANG YOUNG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-24",
"last_updated": "2011-12-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "66449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.