Active NPI
Kelvin Lum, PHARM D.
- Pharmacist
- Folsom, CA
National Provider Identifier
1619970035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 69511
- Practice address
- 430 Blue Ravine Rd
T-1098
Folsom, CA 95630-3402 - Phone
- (916) 850-1195
- NPI assigned
- May 31, 2005
- 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 | 69511 | CA | Primary |
Addresses
Primary practice location
430 Blue Ravine Rd
T-1098
Folsom, CA 95630-3402
Mailing address
430 Blue Ravine Rd
T-1098
Folsom, CA 95630-3402
Phone (916) 850-1195
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70957F | Medicaid | CA | |
| FCH03887F | Medicaid | CA |
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 69511 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1117497600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378166400000",
"number": "1619970035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 BLUE RAVINE RD",
"address_2": "T-1098",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956303402",
"telephone_number": "916-850-1195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "430 BLUE RAVINE RD",
"address_2": "T-1098",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956303402",
"telephone_number": "916-850-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "KELVIN",
"name_prefix": "Dr.",
"credential": "PHARM D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-31",
"last_updated": "2013-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "69511",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FHC70957F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "FCH03887F",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Folsom, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.