Organization Active NPI

Hyungwon Kang

  • Community/Retail Pharmacy
  • Duluth, GA
National Provider Identifier
1083690911
Registry record updated Jun 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE008994 Issued in GA
Legal business name
HYUNGWON KANG
Practice address
2550 Pleasant Hill Rd # Build100
Ste 126
Duluth, GA 30096-4122
Phone
(770) 622-0688
Fax
(770) 622-0689
NPI assigned
Dec 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Hyungwon Kang
Title
Owner Pic
Phone
(770) 622-0688

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHRE008994 GA Primary

Addresses

Primary practice location

2550 Pleasant Hill Rd # Build100
Ste 126
Duluth, GA 30096-4122

Mailing address

2550 Pleasant Hill Rd # Build100
Ste 126
Duluth, GA 30096-4122
Phone (770) 622-0688

Other identifiers 2

IdentifierTypeStateIssuer
422771904AMedicaidGA
1153864OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • CORNER PHARMACY Doing business as

National Provider Directory

National Provider Directory

Locations

2550 Pleasant Hill Rd
Ste 126
Duluth, GA 30096
Phone (770) 622-0688

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307059200000",
    "number": "1083690911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 PLEASANT HILL RD # BUILD100",
            "address_2": "STE 126",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964122",
            "telephone_number": "770-622-0688",
            "fax_number": "770-622-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 PLEASANT HILL RD # BUILD100",
            "address_2": "STE 126",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300964122",
            "telephone_number": "770-622-0688",
            "fax_number": "770-622-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HYUNGWON KANG",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-22",
        "last_updated": "2011-06-03",
        "status": "A",
        "authorized_official_last_name": "KANG",
        "authorized_official_first_name": "HYUNGWON",
        "authorized_official_title_or_position": "OWNER PIC",
        "authorized_official_telephone_number": "770-622-0688"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE008994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "422771904A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1153864",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORNER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duluth, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.