Healthcare Provider Details

I. General information

NPI: 1720322183
Provider Name (Legal Business Name): SIMON TRAN HOANG PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 01/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 MORENA BLVD
SAN DIEGO CA
92117-3650
US

IV. Provider business mailing address

4762 MONONGAHELA ST
SAN DIEGO CA
92117-2417
US

V. Phone/Fax

Practice location:
  • Phone: 858-581-4550
  • Fax:
Mailing address:
  • Phone: 805-252-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number67382
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: