Provider Demographics
NPI:1952835019
Name:KANG, JINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JINA
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 1:341 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3148
Mailing Address - Country:US
Mailing Address - Phone:860-243-8351
Mailing Address - Fax:860-243-0089
Practice Address - Street 1:341 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3148
Practice Address - Country:US
Practice Address - Phone:860-243-8351
Practice Address - Fax:860-243-0089
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-16
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13682183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist