Provider Demographics
NPI:1649683277
Name:VO, MY-DOAN
Entity type:Individual
Prefix:
First Name:MY-DOAN
Middle Name:
Last Name:VO
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 1:17573 LIVE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4413
Mailing Address - Country:US
Mailing Address - Phone:714-856-3667
Mailing Address - Fax:
Practice Address - Street 1:2220 CLARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2521
Practice Address - Country:US
Practice Address - Phone:562-494-1371
Practice Address - Fax:562-494-1831
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist