Provider Demographics
NPI:1225656333
Name:KANG, TERRY JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JOHN
Last Name:KANG
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 1:8707 PINLEY SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-5136
Mailing Address - Country:US
Mailing Address - Phone:702-908-3273
Mailing Address - Fax:
Practice Address - Street 1:2525 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2984
Practice Address - Country:US
Practice Address - Phone:702-256-5521
Practice Address - Fax:702-256-8756
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist