Provider Demographics
NPI:1770051435
Name:YANG, CONNIE KYUNG INN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:KYUNG INN
Last Name:YANG
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 1:25 CRIMSON ROSE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0166
Mailing Address - Country:US
Mailing Address - Phone:714-745-7176
Mailing Address - Fax:
Practice Address - Street 1:191 WOODLAND PKWY
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3010
Practice Address - Country:US
Practice Address - Phone:760-471-9007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist