Provider Demographics
NPI:1700201050
Name:DOAN, PAULINE DUNG
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:DUNG
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 1:13632 NASSAU DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5333
Mailing Address - Country:US
Mailing Address - Phone:714-469-7943
Mailing Address - Fax:
Practice Address - Street 1:16120 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8706
Practice Address - Country:US
Practice Address - Phone:714-469-7943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist