Provider Demographics
NPI:1861080863
Name:TRAN, THINH HUNG (PHARM D)
Entity type:Individual
Prefix:
First Name:THINH
Middle Name:HUNG
Last Name:TRAN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12601 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5504
Mailing Address - Country:US
Mailing Address - Phone:714-623-1467
Mailing Address - Fax:
Practice Address - Street 1:16040 HARBOR BLVD STE K
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-1327
Practice Address - Country:US
Practice Address - Phone:714-531-9988
Practice Address - Fax:714-531-9987
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982919478Medicaid