Provider Demographics
NPI:1093494122
Name:TRAN, NGOC NGUYEN DAN
Entity Type:Individual
Prefix:
First Name:NGOC
Middle Name:NGUYEN DAN
Last Name:TRAN
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 1:10033 TRAPPER MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8906
Mailing Address - Country:US
Mailing Address - Phone:702-416-3391
Mailing Address - Fax:
Practice Address - Street 1:10033 TRAPPER MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-8906
Practice Address - Country:US
Practice Address - Phone:702-416-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist