Provider Demographics
NPI:1609189232
Name:KANG, HYON SOO (BS)
Entity Type:Individual
Prefix:
First Name:HYON
Middle Name:SOO
Last Name:KANG
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MOOREHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2928
Mailing Address - Country:US
Mailing Address - Phone:215-859-3558
Mailing Address - Fax:
Practice Address - Street 1:320 E LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3410
Practice Address - Country:US
Practice Address - Phone:610-384-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-25
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044267L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist