Healthcare Provider Details

I. General information

NPI: 1215195110
Provider Name (Legal Business Name): BAO-ANH THI DINH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E CAPITOL EXPY
SAN JOSE CA
95121-2415
US

IV. Provider business mailing address

1807 MONTAGE CT
SAN JOSE CA
95131
US

V. Phone/Fax

Practice location:
  • Phone: 408-629-6060
  • Fax: 408-629-2544
Mailing address:
  • Phone: 408-821-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: