Provider Demographics
NPI:1144802281
Name:DOAN, NGAN BAO
Entity Type:Individual
Prefix:
First Name:NGAN
Middle Name:BAO
Last Name:DOAN
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 1:305 CHECKERS DR APT 208
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-2251
Mailing Address - Country:US
Mailing Address - Phone:408-964-0324
Mailing Address - Fax:
Practice Address - Street 1:305 CHECKERS DR APT 208
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-2251
Practice Address - Country:US
Practice Address - Phone:408-964-0324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist