Healthcare Provider Details

I. General information

NPI: 1669291118
Provider Name (Legal Business Name): TRISHA TRUC KHONG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 10/10/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 W ORANGE AVE
ANAHEIM CA
92804-3183
US

IV. Provider business mailing address

20250 THAGARD WAY
YORBA LINDA CA
92887-3279
US

V. Phone/Fax

Practice location:
  • Phone: 714-827-3000
  • Fax:
Mailing address:
  • Phone: 714-240-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: