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General NPI Number Information
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NPI Number | 1912439217
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Entity Type | Individual
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Provider Name | RICHARDSARAK SOR DUONG
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Gender | Male
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 1670 E 120TH ST
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City | LOS ANGELES
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State | CA
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Zip | 90059-3026
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Country | US
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Telephone | 424-338-1965
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Fax |
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Provider Business Mailing Address
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Address Line | 1544 REMEMBRANCE DR
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City | PERRIS
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State | CA
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Zip | 92571-2936
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Country | US
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Telephone | 714-232-6700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 76700
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License Number State | CA
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