Active NPI
Sihaneat Pen
- Pharmacist
- Long Beach, CA
National Provider Identifier
1548982861
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 85031
- Practice address
- 4400 E Los Coyotes Diagonal
Long Beach, CA 90815-2819 - Phone
- (562) 833-7856
- NPI assigned
- Sep 13, 2022
- Last updated
- Sep 13, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 85031 | CA | Primary |
Addresses
Primary practice location
4400 E Los Coyotes Diagonal
Long Beach, CA 90815-2819
Mailing address
18438 Vantage Pointe Dr
Rowland Heights, CA 91748-5142
Phone (562) 833-7856
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D8055282 | Other | CA | DRIVER LICENSE |
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 |
|---|---|---|---|
| 85031 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS LLC | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 2
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": "1663027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663027200000",
"number": "1548982861",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18438 VANTAGE POINTE DR",
"city": "ROWLAND HEIGHTS",
"state": "CA",
"postal_code": "917485142",
"telephone_number": "562-833-7856"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 E LOS COYOTES DIAGONAL",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908152819",
"telephone_number": "562-833-7856"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEN",
"first_name": "SIHANEAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-13",
"last_updated": "2022-09-13",
"certification_date": "2022-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "85031",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVER LICENSE",
"identifier": "D8055282",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.