Healthcare Provider Details

I. General information

NPI: 1467279646
Provider Name (Legal Business Name): JINJOO KANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 W WASHINGTON ST BLDG F
SEQUIM WA
98382-3264
US

IV. Provider business mailing address

9733 COLLEGE WAY N
SEATTLE WA
98103-3515
US

V. Phone/Fax

Practice location:
  • Phone: 360-681-2120
  • Fax: 360-681-2962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH61560645
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: