Provider Demographics
NPI:1568897601
Name:KANG, HYE JUNG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HYE
Middle Name:JUNG
Last Name:KANG
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9831 SOLITARY PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2519
Mailing Address - Country:US
Mailing Address - Phone:703-879-3084
Mailing Address - Fax:
Practice Address - Street 1:9831 SOLITARY PL
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-2519
Practice Address - Country:US
Practice Address - Phone:703-879-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211074183500000X
NY050248183500000X
TX38960183500000X
VT3490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist