Provider Demographics
NPI:1649051541
Name:CHUNG, ANGEL KIM (PHARMD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:KIM
Last Name:CHUNG
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 1:5656 W GARDEN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84118-6079
Mailing Address - Country:US
Mailing Address - Phone:385-270-1664
Mailing Address - Fax:
Practice Address - Street 1:5656 W GARDEN RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-6079
Practice Address - Country:US
Practice Address - Phone:385-270-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10076192-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist