Healthcare Provider Details

I. General information

NPI: 1083386007
Provider Name (Legal Business Name): HUNG NGUYEN TRAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 N MEDICAL CENTER DR W
CLOVIS CA
93611-6878
US

IV. Provider business mailing address

4186 W ELLERY WAY
FRESNO CA
93722-3557
US

V. Phone/Fax

Practice location:
  • Phone: 559-387-1900
  • Fax:
Mailing address:
  • Phone: 559-824-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number84854
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: