Provider Demographics
NPI:1386196814
Name:KANG, ISABEL (RPH)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ISABEL
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:7320 SW 154TH TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-6843
Mailing Address - Country:US
Mailing Address - Phone:971-404-6922
Mailing Address - Fax:
Practice Address - Street 1:4855 SW WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3460
Practice Address - Country:US
Practice Address - Phone:503-277-2815
Practice Address - Fax:503-626-4419
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR98091835P2201X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist