Provider Demographics
NPI:1528215597
Name:KANG, LEAH (RPH)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 27TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3838
Mailing Address - Country:US
Mailing Address - Phone:917-941-2780
Mailing Address - Fax:718-544-8414
Practice Address - Street 1:904 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3929
Practice Address - Country:US
Practice Address - Phone:917-941-2780
Practice Address - Fax:718-544-8414
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist