Healthcare Provider Details

I. General information

NPI: 1063392066
Provider Name (Legal Business Name): LAAVI PHARMACY, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5409 CENTRAL AVE STE 19
NEWARK CA
94560-4479
US

IV. Provider business mailing address

5409 CENTRAL AVE STE 19
NEWARK CA
94560-4479
US

V. Phone/Fax

Practice location:
  • Phone: 650-396-6830
  • Fax:
Mailing address:
  • Phone: 650-396-6830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LIEN TRUONG
Title or Position: CEO
Credential:
Phone: 650-396-6830