Healthcare Provider Details

I. General information

NPI: 1356952618
Provider Name (Legal Business Name): DAJAJU PHARMACEUTICALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 SENTER RD STE 100
SAN JOSE CA
95111-1185
US

IV. Provider business mailing address

2611 SENTER RD STE 100
SAN JOSE CA
95111-1185
US

V. Phone/Fax

Practice location:
  • Phone: 408-680-4360
  • Fax:
Mailing address:
  • Phone: 408-680-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TAN VAN NGUYEN
Title or Position: PRESIDENT/CEO/CFO/DIRECTOR
Credential:
Phone: 408-680-4360