Provider Demographics
NPI:1528609435
Name:CHOEDAMPHAI, KIMBERLY (PHARM D)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CHOEDAMPHAI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:SHIRAZI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:60 UPPER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5134
Mailing Address - Country:US
Mailing Address - Phone:310-567-7505
Mailing Address - Fax:
Practice Address - Street 1:60 N MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4454
Practice Address - Country:US
Practice Address - Phone:805-496-9310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist