Bunga Teratai Cemeriang America Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY54391 Issued in CA

Legal business name

BUNGA TERATAI CEMERIANG AMERICA INC

Doing business as

Ken Pharmacy

Practice address

583 E Foothill Blvd
Units 7 and 8
Upland, CA 91786-3995

Phone

(909) 579-0719

Fax

(909) 579-0721

NPI assigned

May 10, 2016

Organization subpart

No

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

Authorized official

Name

Suken JongNPI 1255642203

Title

Owner

Phone

(909) 579-0719

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Ken Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Suken Jong

  • Pharmacist
  • Rancho Cucamonga, CA
  • NPI 1255642203
  NPD Authorized official

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467676800000",
    "number": "1881040863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "583 E FOOTHILL BLVD",
            "address_2": "UNITS 7 & 8",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863995",
            "telephone_number": "909-579-0719",
            "fax_number": "909-579-0721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "583 E FOOTHILL BLVD",
            "address_2": "UNITS 7 AND 8",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917863995",
            "telephone_number": "909-579-0719",
            "fax_number": "909-579-0721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUNGA TERATAI CEMERIANG AMERICA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-07-05",
        "status": "A",
        "authorized_official_last_name": "JONG",
        "authorized_official_first_name": "SUKEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-579-0719"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY54391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881040863",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2160375",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ken Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Trannette Brunson
• Patrick J Bryan, M.D.
• Veronica Bueno
• Mary Phuong Bui
• Stephanie Bunawan
• Holli Dillon Burgos, RDHAP
• Jasmin Burgos
• Butay and Phui, Dental Corporation
• Nelson Butay, DDS
• Robert Patrick Byrne, DC

• Community/Retail Pharmacy in Upland, CA
• Providers in Upland, 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 5, 2016; 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.