MEDICARE: SUSAN J KANG PHARM.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	68177	CA

General Provider Information

NPI Number	:	1114399060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J KANG PHARM.D

Provider Business Mailing Address
First Line	:	3925 N RIVER RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-6914
Country	:	US
Telephone Number	:	760-757-9348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 N RIVER RD
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92058-6914
Country	:	US
Telephone Number	:	760-757-9348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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