Provider Demographics
NPI:1942467097
Name:KANG, JI HYUN
Entity Type:Individual
Prefix:MISS
First Name:JI
Middle Name:HYUN
Last Name:KANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JI
Other - Middle Name:HYUN
Other - Last Name:KANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1155 S HAVANA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4019
Mailing Address - Country:US
Mailing Address - Phone:720-988-8387
Mailing Address - Fax:
Practice Address - Street 1:4222 S BLACKHAWK CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-8109
Practice Address - Country:US
Practice Address - Phone:720-988-8387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist