Active NPI
Phu Cuong Quang Sam, PHARM. D.
- Pharmacist
- Corona, CA
National Provider Identifier
1225447121
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 51470
- Practice address
- 760 Washburn Ave Ste 1
Corona, CA 92882-3303 - Phone
- (951) 371-2003
- NPI assigned
- Aug 5, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 51470 | CA | Primary |
| Pharmacist | 183500000X | 14891 | NV |
Addresses
Primary practice location
760 Washburn Ave Ste 1
Corona, CA 92882-3303
Mailing address
18567 Callens Cir
Fountain Valley, CA 92708-6622
Phone (714) 489-3075
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14891 | NV | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407196800000",
"number": "1225447121",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18567 CALLENS CIR",
"city": "FOUNTAIN VALLEY",
"state": "CA",
"postal_code": "927086622",
"telephone_number": "714-489-3075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "760 WASHBURN AVE STE 1",
"city": "CORONA",
"state": "CA",
"postal_code": "928823303",
"telephone_number": "951-371-2003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "PHU CUONG",
"middle_name": "QUANG",
"name_prefix": "Dr.",
"credential": "PHARM. D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-05",
"last_updated": "2014-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "51470",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NV",
"license": "14891",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.