MEDICARE: KEVIN SANG PHUNG PHARM.D.

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	RPH-0014412	OR

General Provider Information

NPI Number	:	1780139519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN SANG PHUNG PHARM.D.

Provider Business Mailing Address
First Line	:	3101 WESTERN AVE STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-3017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 WESTERN AVE STE 100
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98121-3017
Country	:	US
Telephone Number	:	800-523-3080
Fax Number	:

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

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	12/31/2016

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