Provider Demographics
NPI:1588128045
Name:KANG, PAUL C (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:KANG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 S REINO RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4267
Mailing Address - Country:US
Mailing Address - Phone:805-499-4006
Mailing Address - Fax:805-376-2461
Practice Address - Street 1:451 S REINO RD
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4267
Practice Address - Country:US
Practice Address - Phone:805-499-4006
Practice Address - Fax:805-376-2461
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty