KDJ Healthcare Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

KDJ HEALTHCARE INC

Practice address

2781-2783 W. Olympic Blvd.
Los Angeles, CA 90006-2632

Phone

(213) 816-0270

Fax

(213) 816-0271

NPI assigned

Apr 3, 2007

Organization subpart

No

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

Authorized official

Name

Olivia Thai

Title

Ceo

Phone

(213) 816-0270

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 986 Pharmacy #8010 Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Tax ID family

986 Pharmacy 80102 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.

• KDJ Healthcare Inc

  • Long Term Care Pharmacy
  • Los Angeles, CA
  • NPI 1518713585
  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.

• Grace Yaisol Kim

  • Pharmacist
  • Los Angeles, CA
  • NPI 1194460063
  NPD (past)
• Leanna Dayoung Kim

  • Pharmacist
  • Los Angeles, CA
  • NPI 1811864226
  NPD (past)
• Cindy Lin, PHARM.D.

  • Pharmacist
  • Los Angeles, CA
  • NPI 1548627318
  NPD (past)
• Kenneth K Yee, PHARM D

  • Pharmacist
  • Los Angeles, CA
  • NPI 1962563387
  NPD (past)

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672099200000",
    "number": "1336260348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2781-2783 W. OLYMPIC BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062632",
            "telephone_number": "213-816-0270",
            "fax_number": "213-816-0271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2781-2783 W. OLYMPIC BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900062632",
            "telephone_number": "213-816-0270",
            "fax_number": "213-816-0271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KDJ HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A",
        "authorized_official_last_name": "THAI",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "213-816-0270"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA BOARD OF PHARMACY",
            "identifier": "58812",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "986 Pharmacy #8010",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "986 Pharmacy #8010",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dong Qing Ke, ACUPUNCTURIST
• Jasmine C Ke, MD
• Michelle Ke, PHARMD

• Community/Retail Pharmacy in Los Angeles, CA
• Providers in Los Angeles, 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 Dec 27, 2022; 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.