Provider Demographics
NPI:1629579651
Name:DOAN, ANH TRANG
Entity Type:Individual
Prefix:
First Name:ANH
Middle Name:TRANG
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 1:3600 W MCFADDEN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-1306
Mailing Address - Country:US
Mailing Address - Phone:714-775-7501
Mailing Address - Fax:714-775-8002
Practice Address - Street 1:3600 W MCFADDEN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-1306
Practice Address - Country:US
Practice Address - Phone:714-775-7501
Practice Address - Fax:714-775-8002
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA635241183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist