Provider Demographics
NPI:1699159087
Name:BANG, MI HWA
Entity type:Individual
Prefix:
First Name:MI HWA
Middle Name:
Last Name:BANG
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 1:22554 VENTURA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-1413
Mailing Address - Country:US
Mailing Address - Phone:818-222-9877
Mailing Address - Fax:818-222-7389
Practice Address - Street 1:22554 VENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1413
Practice Address - Country:US
Practice Address - Phone:818-222-9877
Practice Address - Fax:818-222-7389
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 56982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH 56982OtherRPH