Healthcare Provider Details

I. General information

NPI: 1952667941
Provider Name (Legal Business Name): VINCENT HUA DO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8030 DALE ST
BUENA PARK CA
90620-2251
US

IV. Provider business mailing address

5002 W LEHNHARDT AVE
SANTA ANA CA
92704-1944
US

V. Phone/Fax

Practice location:
  • Phone: 714-527-2396
  • Fax:
Mailing address:
  • Phone: 714-423-9663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: