Provider Demographics
NPI:1275200222
Name:KHANG, DONGKOO
Entity Type:Individual
Prefix:
First Name:DONGKOO
Middle Name:
Last Name:KHANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E WINE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-1062
Mailing Address - Country:US
Mailing Address - Phone:509-882-1060
Mailing Address - Fax:
Practice Address - Street 1:610 E WINE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-1062
Practice Address - Country:US
Practice Address - Phone:509-882-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR61182985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist