Provider Demographics
NPI:1235778184
Name:CAO, SUSAN JEUNG KANG (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JEUNG KANG
Last Name:CAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:JEUNG
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3142 G ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-1368
Mailing Address - Country:US
Mailing Address - Phone:209-383-9086
Mailing Address - Fax:
Practice Address - Street 1:3142 G ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-1368
Practice Address - Country:US
Practice Address - Phone:209-383-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-24
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist