Provider Demographics
NPI:1295318160
Name:KUG, JAE EUN (PHARMD)
Entity type:Individual
Prefix:
First Name:JAE EUN
Middle Name:
Last Name:KUG
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 1:21488 COLD SPRING LN
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3813
Mailing Address - Country:US
Mailing Address - Phone:909-643-6304
Mailing Address - Fax:
Practice Address - Street 1:21488 COLD SPRING LN
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3813
Practice Address - Country:US
Practice Address - Phone:909-643-6304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist