Provider Demographics
NPI:1639041924
Name:TRUONG, KHANH PHUONG PHAN
Entity type:Individual
Prefix:
First Name:KHANH PHUONG
Middle Name:PHAN
Last Name:TRUONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6013
Mailing Address - Country:US
Mailing Address - Phone:513-868-1667
Mailing Address - Fax:
Practice Address - Street 1:1090 HIGH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-6013
Practice Address - Country:US
Practice Address - Phone:513-868-1667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03445991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist