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General NPI Number Information
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NPI Number | 1083690911
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Entity Type | Organization
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Legal Business Name | HYUNGWON KANG
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 2550 PLEASANT HILL RD # BUILD100 STE 126
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City | DULUTH
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State | GA
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Zip | 30096-4122
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Country | US
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Telephone | 770-622-0688
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Fax | 770-622-0689
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Provider Business Mailing Address
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Address Line | 2550 PLEASANT HILL RD # BUILD100 STE 126
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City | DULUTH
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State | GA
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Zip | 30096-4122
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Country | US
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Telephone | 770-622-0688
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Fax | 770-622-0689
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Authorized Official
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Title or Position | OWNER PIC
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Name | HYUNGWON KANG
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Credential |
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Telephone | 770-622-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHRE008994
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License Number State | GA
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