MEDICARE: MICHELLE KYONGMIN KANG

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	58441	CA
2	183500000X	Pharmacist	5302030471	MI

General Provider Information

NPI Number	:	1730338526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KYONGMIN KANG

Provider Business Mailing Address
First Line	:	6130 W SUNSET BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-6424
Country	:	US
Telephone Number	:	323-467-4201
Fax Number	:

Provider Business Practice Location Address
First Line	:	6130 W SUNSET BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-6424
Country	:	US
Telephone Number	:	323-467-4201
Fax Number	:

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

Provider Enumeration Date	:	09/16/2008
Last Update Date	:	09/16/2008

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Directions to “ MICHELLE KYONGMIN KANG ” Practice Location

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