MEDICARE: DR. TERRY JOHN KANG PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19426	NV

General Provider Information

NPI Number	:	1225656333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY JOHN KANG PHARMD

Provider Business Mailing Address
First Line	:	8707 PINLEY SPRING ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-5136
Country	:	US
Telephone Number	:	702-908-3273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 S BUFFALO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2984
Country	:	US
Telephone Number	:	702-256-5521
Fax Number	:	702-256-8756

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	07/07/2020

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