Healthcare Provider Details

I. General information

NPI: 1871296830
Provider Name (Legal Business Name): KEVIN HOAN YONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 LEGION RD
DENTON MD
21629-2040
US

IV. Provider business mailing address

PO BOX 2292
SALISBURY MD
21802-2292
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-0868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0015873
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29059
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: