Provider Demographics
NPI:1588025548
Name:BANG, SOYANG
Entity Type:Individual
Prefix:
First Name:SOYANG
Middle Name:
Last Name:BANG
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 1:370 W ALAMEDA AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-3361
Mailing Address - Country:US
Mailing Address - Phone:904-673-4742
Mailing Address - Fax:
Practice Address - Street 1:370 W ALAMEDA AVE APT 105
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-3361
Practice Address - Country:US
Practice Address - Phone:904-673-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist