K-Moa Healthcare, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

55791 Issued in CA

Legal business name

K-MOA HEALTHCARE, INC.

Doing business as

K's Pharmacy

Practice address

12582 Central Ave
Chino, CA 91710-3507

Phone

(909) 591-7429

Fax

(909) 902-9480

NPI assigned

Aug 15, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Diane KimNPI 1821363011

Title

Secretary/Pic

Phone

(909) 591-7429

Specialties & licenses 1

Addresses

Other names 1

• K's Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Diane Deoksu Kim, PHARM.D.

  • Pharmacist
  • Chino, CA
  • NPI 1821363011
  NPD Authorized official
• Jin Ho Kim, PHARMACIST

  • Pharmacist
  • Chino, CA
  • NPI 1376605477
  NPD (past)

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

{
    "created_epoch": "1502755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1386160919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12582 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103507",
            "telephone_number": "909-591-7429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12582 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103507",
            "telephone_number": "909-591-7429",
            "fax_number": "909-902-9480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K-MOA HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-15",
        "last_updated": "2022-07-21",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "SECRETARY/PIC",
        "authorized_official_telephone_number": "909-591-7429",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "55791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "K's Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jennifer Jung Fuchs, MS, BCBA, LBA
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• Pranav Nil Kachhi, M.D.
• Shrina Kadivar
• Kaiser
• Kaiser Foundation Health Plan Inc
• Stuart A Kaplowitz, MFT

• Community/Retail Pharmacy in Chino, CA
• Providers in Chino, 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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.