Provider Demographics
NPI:1710652391
Name:KANG, JEE HAE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEE HAE
Middle Name:
Last Name:KANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 7TH ST APT 403
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2271
Mailing Address - Country:US
Mailing Address - Phone:310-463-2030
Mailing Address - Fax:
Practice Address - Street 1:15150 W SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3720
Practice Address - Country:US
Practice Address - Phone:310-454-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-15
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC48982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist