Provider Demographics
NPI:1881158996
Name:LUU, XUAN TRANG THI
Entity type:Individual
Prefix:
First Name:XUAN TRANG
Middle Name:THI
Last Name:LUU
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 1:701 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3229
Mailing Address - Country:US
Mailing Address - Phone:415-848-1088
Mailing Address - Fax:628-221-5821
Practice Address - Street 1:701 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3229
Practice Address - Country:US
Practice Address - Phone:415-848-1088
Practice Address - Fax:628-221-5821
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79692183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH79692OtherPHARMACIST LICENSE NUMBER