Active NPI
Hyungwon Kang
- Community/Retail Pharmacy
- Duluth, GA
National Provider Identifier
1083690911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- PHRE008994
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 422771904A | Medicaid | GA | |
| 1153864 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER |
Other names 1
- CORNER PHARMACY
National Provider Directory
National Provider DirectoryLocations
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.
-
- Pharmacist
- Duluth, GA
- NPI 1780767632
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.