Provider Demographics
NPI:1346851706
Name:HANG, SHANNON KIM-LIEN
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:KIM-LIEN
Last Name:HANG
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 1:2532 W VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-1934
Mailing Address - Country:US
Mailing Address - Phone:626-308-1001
Mailing Address - Fax:626-308-1418
Practice Address - Street 1:2532 W VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-1934
Practice Address - Country:US
Practice Address - Phone:626-308-1001
Practice Address - Fax:626-308-1418
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist