Provider Demographics
NPI:1255666723
Name:PANG, KINYING CONNIE
Entity Type:Individual
Prefix:
First Name:KINYING
Middle Name:CONNIE
Last Name:PANG
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 1:15510 W BELL RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3436
Mailing Address - Country:US
Mailing Address - Phone:623-546-2565
Mailing Address - Fax:623-544-2992
Practice Address - Street 1:15510 W BELL RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3436
Practice Address - Country:US
Practice Address - Phone:623-546-2565
Practice Address - Fax:623-544-2992
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13657183500000X
OH03120920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist