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General NPI Number Information
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NPI Number | 1780139519
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Entity Type | Individual
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Provider Name | KEVIN SANG PHUNG PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 12/31/2016
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Provider Practice Location Address
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Address Line | 3101 WESTERN AVE STE 100
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City | SEATTLE
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State | WA
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Zip | 98121-3017
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Country | US
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Telephone | 800-523-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 3101 WESTERN AVE STE 100
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City | SEATTLE
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State | WA
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Zip | 98121-3017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH-0014412
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License Number State | OR
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