Healthcare Provider Details

I. General information

NPI: 1346730116
Provider Name (Legal Business Name): VINH LE TRAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12666 BROOKHURST ST. SUITE 110
GARDEN GROVE CA
92840
US

IV. Provider business mailing address

12666 BROOKHURST ST. SUITE 110
GARDEN GROVE CA
92840
US

V. Phone/Fax

Practice location:
  • Phone: 714-705-6992
  • Fax: 714-591-0591
Mailing address:
  • Phone: 714-705-6992
  • Fax: 714-591-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number59831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: