Healthcare Provider Details

I. General information

NPI: 1336094176
Provider Name (Legal Business Name): BO YOON KANG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 23RD AVE S
FARGO ND
58104-7927
US

IV. Provider business mailing address

5601 34TH AVE S APT 120
FARGO ND
58104-7306
US

V. Phone/Fax

Practice location:
  • Phone: 909-251-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6627
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: