Individual
THI HAI DUONG PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4200 TRABUCO RD, IRVINE, CA 92620-3600
(949) 861-3170
(949) 861-3179
Mailing address
308 TONOPAH AVE, LA PUENTE, CA 91744-3532
(626) 757-3481
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
77808
CA
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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