Healthcare Provider Details

I. General information

NPI: 1477848273
Provider Name (Legal Business Name): YOON KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 41ST AVE
CAPITOLA CA
95010-2908
US

IV. Provider business mailing address

321 FLORA LN
SCOTTS VALLEY CA
95066-4976
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-7282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number55518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: