Healthcare Provider Details

I. General information

NPI: 1164310512
Provider Name (Legal Business Name): TRUNG DOAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 W CANYON AVE
SAN DIEGO CA
92123-4653
US

IV. Provider business mailing address

2921 W CANYON AVE
SAN DIEGO CA
92123-4653
US

V. Phone/Fax

Practice location:
  • Phone: 619-708-2698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number52673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: