Provider Demographics
NPI:1023445350
Name:KANG, JIN HYUNG (PHARM D)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:HYUNG
Last Name:KANG
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 GEORGE DIETER DR
Mailing Address - Street 2:APT 1003
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7663
Mailing Address - Country:US
Mailing Address - Phone:201-937-5755
Mailing Address - Fax:
Practice Address - Street 1:2879 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-2407
Practice Address - Country:US
Practice Address - Phone:915-566-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist