Provider Demographics
NPI:1639497571
Name:DOAN, DUNG MY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DUNG
Middle Name:MY
Last Name:DOAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MY
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20220 LANDIG CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3262
Mailing Address - Country:US
Mailing Address - Phone:714-386-0857
Mailing Address - Fax:
Practice Address - Street 1:405 W IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4818
Practice Address - Country:US
Practice Address - Phone:714-529-2176
Practice Address - Fax:714-529-8834
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH49991183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist