HYUNGWON KANG
2550 Pleasant Hill Rd # Build100 Ste 126
Duluth, GA 30096
770-622-0688
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 333600000X | Suppliers - Pharmacy - | ||
Y | 3336C0003X | Suppliers - Pharmacy | GA | PHRE008994 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
422771904A | GA | MEDICAID | |
NCPDP PROVIDER IDENTIFICATION NUMBER | 1153864 | OTHER |