Provider Demographics
NPI:1619582962
Name:TRAN, SAU VAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAU
Middle Name:VAN
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3704
Mailing Address - Country:US
Mailing Address - Phone:949-453-9789
Mailing Address - Fax:949-453-9235
Practice Address - Street 1:16300 SAND CANYON AVE STE 101
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3704
Practice Address - Country:US
Practice Address - Phone:949-453-9789
Practice Address - Fax:949-453-9235
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist