Healthcare Provider Details

I. General information

NPI: 1497076541
Provider Name (Legal Business Name): VAN Q TRAN PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10989 VENTURA BLVD
STUDIO CITY CA
91604-3341
US

IV. Provider business mailing address

14321 HOPE ST
GARDEN GROVE CA
92843-4621
US

V. Phone/Fax

Practice location:
  • Phone: 818-980-1797
  • Fax:
Mailing address:
  • Phone: 714-394-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: