Provider Demographics
NPI:1518954684
Name:TRAN, KIM OANH THI (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIM OANH
Middle Name:THI
Last Name:TRAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14536 BROOKHURST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5750
Mailing Address - Country:US
Mailing Address - Phone:714-775-6677
Mailing Address - Fax:714-775-6595
Practice Address - Street 1:14536 BROOKHURST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5750
Practice Address - Country:US
Practice Address - Phone:714-775-6677
Practice Address - Fax:714-775-6595
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA403060Medicaid
CA0570146OtherNABP
CA0570146OtherNABP
CAPHA403060Medicaid