Provider Demographics
NPI:1366924110
Name:KUANG, CONNIE XIAMIN
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:XIAMIN
Last Name:KUANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 EVENING SUN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1023
Mailing Address - Country:US
Mailing Address - Phone:702-767-8128
Mailing Address - Fax:
Practice Address - Street 1:3405 EVENING SUN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1023
Practice Address - Country:US
Practice Address - Phone:702-767-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist