Provider Demographics
NPI:1962720086
Name:HUNG, JOHNNY KIN MAN (RPH)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:KIN MAN
Last Name:HUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:DR
Other - First Name:KIN MAN
Other - Middle Name:JOHNNY
Other - Last Name:HUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:189 SCHERMERHORN ST APT 12G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6198
Mailing Address - Country:US
Mailing Address - Phone:347-286-9593
Mailing Address - Fax:
Practice Address - Street 1:123 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3503
Practice Address - Country:US
Practice Address - Phone:201-488-0654
Practice Address - Fax:201-883-1619
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-13
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03163200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4347307Medicaid