Active NPI
Thi Hai Duong Phan
- Community/Retail Pharmacy
- Irvine, CA
National Provider Identifier
1174095194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 77808
- Practice address
- 4200 Trabuco Rd
Irvine, CA 92620-3600 - Phone
- (949) 861-3170
- Fax
- (949) 861-3179
- NPI assigned
- Jan 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 77808 | CA | Primary |
Addresses
Primary practice location
4200 Trabuco Rd
Irvine, CA 92620-3600
Mailing address
308 Tonopah Ave
La Puente, CA 91744-3532
Phone (626) 757-3481
Other names 1
- Hai Duong Phan
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77808 | CA | MD | Community/Retail Pharmacy |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546387200000",
"number": "1174095194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 TONOPAH AVE",
"city": "LA PUENTE",
"state": "CA",
"postal_code": "917443532",
"telephone_number": "626-757-3481"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 TRABUCO RD",
"city": "IRVINE",
"state": "CA",
"postal_code": "926203600",
"telephone_number": "949-861-3170",
"fax_number": "949-861-3179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAN",
"first_name": "THI HAI DUONG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-02",
"last_updated": "2019-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "77808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "HAI DUONG",
"last_name": "PHAN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.