MEDICARE: TA KANG WANG PHARMD

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	84568	CA

General Provider Information

NPI Number	:	1588498349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TA KANG WANG PHARMD

Provider Business Mailing Address
First Line	:	216 BRANDYWINE CT
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-2260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4950 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-5821
Country	:	US
Telephone Number	:	626-290-8572
Fax Number	:

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	10/28/2024

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Directions to “ TA KANG WANG PHARMD” Practice Location

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