Provider Demographics
NPI:1437520798
Name:DANG, KRISTEN PHUONG (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PHUONG
Last Name:DANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:
Other - Last Name:DANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10645 COLOMA RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3938
Mailing Address - Country:US
Mailing Address - Phone:603-854-1119
Mailing Address - Fax:
Practice Address - Street 1:7010 AUBURN BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4342
Practice Address - Country:US
Practice Address - Phone:916-729-8077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist