Active NPI
Kevin Wing Jang, RPH
- Pharmacist
- Puyallup, WA
National Provider Identifier
1922308733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00042082
- Practice address
- 11501 Canyon Rd E
Puyallup, WA 98373-4359 - Phone
- (253) 536-5296
- Fax
- (253) 536-5508
- NPI assigned
- Oct 26, 2010
- Last updated
- Oct 26, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH00042082 | WA | Primary |
Addresses
Primary practice location
11501 Canyon Rd E
Puyallup, WA 98373-4359
Mailing address
11501 Canyon Rd E
Puyallup, WA 98373-4359
Phone (253) 536-5296
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH00042082 | WA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Safeway Inc | Past | Accepting new patients | |
| Safeway Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1288051200000",
"number": "1922308733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11501 CANYON RD E",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983734359",
"telephone_number": "253-536-5296",
"fax_number": "253-536-5508"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11501 CANYON RD E",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983734359",
"telephone_number": "253-536-5296",
"fax_number": "253-536-5508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JANG",
"first_name": "KEVIN",
"middle_name": "WING",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-10-26",
"last_updated": "2010-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00042082",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.