Provider Demographics
NPI:1063861466
Name:DANG, KEVIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:DANG
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:PO BOX 731556
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95173-1556
Mailing Address - Country:US
Mailing Address - Phone:408-270-0670
Mailing Address - Fax:855-274-7399
Practice Address - Street 1:2690 S WHITE RD
Practice Address - Street 2:SUITE 200-A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2076
Practice Address - Country:US
Practice Address - Phone:408-270-0670
Practice Address - Fax:855-274-7399
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA488021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist