Provider Demographics
NPI:1013275320
Name:DANG, KEVIN KHUONG (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:KHUONG
Last Name:DANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KHUONG
Other - Middle Name:HONG PHAM
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACY DOCTORATE
Mailing Address - Street 1:23417 N. 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2295
Practice Address - Country:US
Practice Address - Phone:602-251-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ159301835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15930-RPHOtherIMMUNIZATION PROGRAM