Provider Demographics
NPI:1174048870
Name:TRAN, DONG PHUONG THIEN (RPH)
Entity type:Individual
Prefix:
First Name:DONG PHUONG
Middle Name:THIEN
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 N CEDAR AVE APT 239
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1037
Mailing Address - Country:US
Mailing Address - Phone:402-613-9376
Mailing Address - Fax:
Practice Address - Street 1:875 N ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-3002
Practice Address - Country:US
Practice Address - Phone:559-595-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA76634OtherCAILFORNIA STATE BOARD OF PHARMACY