Provider Demographics
NPI:1528151222
Name:YEH, KYEUNG SUK (RPH)
Entity type:Individual
Prefix:
First Name:KYEUNG
Middle Name:SUK
Last Name:YEH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 S WESTERN AVE #103
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1014
Mailing Address - Country:US
Mailing Address - Phone:323-733-7788
Mailing Address - Fax:323-733-4818
Practice Address - Street 1:966 S WESTERN AVE #103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1014
Practice Address - Country:US
Practice Address - Phone:323-733-7788
Practice Address - Fax:323-733-4818
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44173183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA402690Medicaid
1129730001Medicare NSC