| Doctor Name: | MR. TEP M KANG |
| NPI Number: | 1164620183 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PHARMD, BCPS |
| License Number: | A1-002858 |
| Business Practice Address: | 20 Clemson Dr Garnet Valley, PA - 190611621 |
| Business Phone Number: | 6103582235 |
| Business Fax Number: | |
| Mailing Address: | 4755 Ogletown-stanton Road, NEWARK |
| State: | DE |
| Postal Code: | 197180001 |
| Phone Number: | 3027336333 |
| Fax Number: | |
| NPI Enumeration Date: | 07/11/2007 |
| NPI Last Update Date: | 07/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835N1003X |
| License Number: | A1-002858 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Nutrition Support |
| Taxonomy Definition: | A licensed pharmacist who has demonstrated specialized knowledge and skill in maintenance and/or restoration of optimal nutritional status, designing and modifying treatment according to patient needs. |