1881683191 NPI number — MR. PHU TRONG TRAN RPH DPH

Table of content: MR. PHU TRONG TRAN RPH DPH (NPI 1881683191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881683191 NPI number — MR. PHU TRONG TRAN RPH DPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
PHU
Provider Middle Name:
TRONG
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPH DPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881683191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 E MILL ST
Provider Second Line Business Mailing Address:
STE 14
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92408-1548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-387-0932
Provider Business Mailing Address Fax Number:
909-381-3592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 E MILL ST
Provider Second Line Business Practice Location Address:
STE 14
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92408-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-387-0932
Provider Business Practice Location Address Fax Number:
909-381-3592
Provider Enumeration Date:
10/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PHY37070 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA370700 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0546931 . This is a "NAPB" identifier . This identifiers is of the category "OTHER".




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