Provider Demographics
NPI:1376108449
Name:TIANG, SUK KING
Entity Type:Individual
Prefix:
First Name:SUK KING
Middle Name:
Last Name:TIANG
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 1:915 E ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5800
Mailing Address - Country:US
Mailing Address - Phone:626-332-7213
Mailing Address - Fax:626-331-7545
Practice Address - Street 1:915 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-5800
Practice Address - Country:US
Practice Address - Phone:626-332-7213
Practice Address - Fax:626-331-7545
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51395183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty