Healthcare Provider Details

I. General information

NPI: 1053585927
Provider Name (Legal Business Name): LAN THI TRAN NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 05/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10042 LAMPSON AVE
GARDEN GROVE CA
92840-4703
US

IV. Provider business mailing address

10042 LAMPSON AVE
GARDEN GROVE CA
92840-4703
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-3819
  • Fax: 714-537-8205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY49001
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAN TRAN
Title or Position: PIC
Credential:
Phone: 562-355-3831