Provider Demographics
NPI:1053661793
Name:KHOWONG, MATTHEW CHIENG (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHIENG
Last Name:KHOWONG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26-01 KIPP STREET
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3242
Mailing Address - Country:US
Mailing Address - Phone:201-835-4209
Mailing Address - Fax:
Practice Address - Street 1:26-01 KIPP STREET
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3242
Practice Address - Country:US
Practice Address - Phone:201-835-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RJ04230183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist