Healthcare Provider Details

I. General information

NPI: 1780668178
Provider Name (Legal Business Name): TRANG HUONG SPARKS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRANG HUONG NGUYEN

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E. SECOND STREET SUITE 5
POMONA CA
91766-2007
US

IV. Provider business mailing address

1601 MONTE VISTA AVE STE 100
CLAREMONT CA
91711-6601
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-2565
  • Fax: 909-865-2955
Mailing address:
  • Phone: 909-865-2565
  • Fax: 909-865-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 14758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: