Provider Demographics
NPI:1770139180
Name:VO, TRANG THIEN
Entity type:Individual
Prefix:DR
First Name:TRANG
Middle Name:THIEN
Last Name:VO
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 1:34101 FREMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2230
Mailing Address - Country:US
Mailing Address - Phone:510-794-0735
Mailing Address - Fax:510-794-0781
Practice Address - Street 1:34101 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2230
Practice Address - Country:US
Practice Address - Phone:510-794-9735
Practice Address - Fax:510-794-0784
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083758155OtherCOMMUNITY PHARMACY
CA1083758155Medicaid
CA1083758155OtherLUCKY PHARMACY