Active NPI
Kingman Chan
- Pharmacist
- La Puente, CA
National Provider Identifier
1629486691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 59783
- Practice address
- 1425 N Hacienda Blvd
La Puente, CA 91744-1133 - Phone
- (626) 251-1906
- Fax
- (626) 251-1878
- NPI assigned
- Jul 23, 2014
- Last updated
- Jul 23, 2014
- 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 | 59783 | CA | Primary |
Addresses
Primary practice location
1425 N Hacienda Blvd
La Puente, CA 91744-1133
Mailing address
1425 N Hacienda Blvd
La Puente, CA 91744-1133
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 |
|---|---|---|---|
| 59783 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walmart Inc. | Past | Accepting new patients | |
| Walmart Inc. | 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": "1406073600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406073600000",
"number": "1629486691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1425 N HACIENDA BLVD",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917441133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 N HACIENDA BLVD",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917441133",
"telephone_number": "626-251-1906",
"fax_number": "626-251-1878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHAN",
"first_name": "KINGMAN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-23",
"last_updated": "2014-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "59783",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Puente, CA
- Kevin Edgar Cazares, PPS
- Marlene Ceja Coronado
- Jennie Ceniceros
- Central City Community Health Center Inc
- Chan, Chan, Chen & Luu, DDS, Inc. (Fairgrove Family Dentistry)
- Chanukya Dasari MD a Professional Corporation
- Eloisa Chavez
- Che Investment Enterprises Inc (Clinica Medica San Pedro La Puente)
- Peter Chen
- Shu Chen Chen
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.