KKN Pharmacy Corporation

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

51753 Issued in CA

Legal business name

KKN PHARMACY CORPORATION

Practice address

27881 La Paz Rd Ste E
Laguna Niguel, CA 92677-3933

Phone

(949) 643-0740

Fax

(949) 643-2287

NPI assigned

Jul 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nihar Mandavia, PHARMDNPI 1023205291

Title

President

Phone

(949) 643-0740

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• The Druggist Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

KKN Pharmacy Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• KKN Pharmacy Corporation

  • Long Term Care Pharmacy
  • Laguna Niguel, CA
  • NPI 1699505701
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nihar Niranjan Mandavia, PHARM.D.

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Laguna Niguel, CA
  • NPI 1023205291
  NPD Authorized official
• Chad Leung

  • Pharmacist
  • Laguna Niguel, CA
  • NPI 1366318156
  NPD
• Brenda Dinh, RPH

  • Pharmacist
  • Laguna Niguel, CA
  • NPI 1508522186
  NPD (past)
• Narita Phu, PHARM. D.

  • Pharmacist
  • Laguna Niguel, CA
  • NPI 1992256838
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722729600000",
    "number": "1104859800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27881 LA PAZ RD STE E",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926773933",
            "telephone_number": "949-643-0740",
            "fax_number": "949-643-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27881 LA PAZ RD STE E",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926773933",
            "telephone_number": "949-643-0740",
            "fax_number": "949-643-2287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KKN PHARMACY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-08-04",
        "certification_date": "2024-08-04",
        "status": "A",
        "authorized_official_last_name": "MANDAVIA",
        "authorized_official_first_name": "NIHAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-643-0740",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "51753",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144868",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Druggist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kimberly V. Fogarty, Licensed Marriage & Family Therapy, PC
• Kimberly Ward DDS, Inc.
• Sherry Marie King-Rockman, MFCC
• Monica Kinneberg, CMT
• Travis Wayne Kinser, DDS
• KKN Pharmacy Corporation
• Lorrie J Klein, M.D.
• Marti Lynn Klein
• Edyta Klimek, O.D.
• Edward D Klinicke

• Community/Retail Pharmacy in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.