Provider Demographics
NPI:1083603476
Name:NTT CORPORATION
Entity Type:Organization
Organization Name:NTT CORPORATION
Other - Org Name:KIEU AN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:NHI
Authorized Official - Middle Name:HANH HGUYEN
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-280-0466
Mailing Address - Street 1:600 E VALLEY BLVD
Mailing Address - Street 2:#G
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3673
Mailing Address - Country:US
Mailing Address - Phone:626-280-0466
Mailing Address - Fax:626-572-0569
Practice Address - Street 1:600 E VALLEY BLVD
Practice Address - Street 2:#G
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3673
Practice Address - Country:US
Practice Address - Phone:626-280-0466
Practice Address - Fax:626-572-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 51153333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY 51153OtherRETAIL PHARMACY PERMIT
CA05-90198OtherNCPDP