Provider Demographics
NPI:1205503232
Name:WANG, JOHN BYUNGHO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BYUNGHO
Last Name:WANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9610 RIDGEHAVEN CT STE A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-5603
Mailing Address - Country:US
Mailing Address - Phone:619-543-7453
Mailing Address - Fax:
Practice Address - Street 1:9610 RIDGEHAVEN CT STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-5603
Practice Address - Country:US
Practice Address - Phone:619-543-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist