Provider Demographics
NPI:1902659568
Name:ONG, KIMBERLY THIEN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THIEN
Last Name:ONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 ALLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8480
Mailing Address - Country:US
Mailing Address - Phone:951-880-4466
Mailing Address - Fax:
Practice Address - Street 1:32575 GOLDEN LANTERN ST
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3248
Practice Address - Country:US
Practice Address - Phone:949-248-4803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist