Healthcare Provider Details

I. General information

NPI: 1992660534
Provider Name (Legal Business Name): VENG HOUT TY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 UNIVERSITY AVE
SAN DIEGO CA
92104-2039
US

IV. Provider business mailing address

3804 E WALNUT AVE
ORANGE CA
92869-2851
US

V. Phone/Fax

Practice location:
  • Phone: 619-283-7366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: