1821081910 NPI number — DR. BEATLE THIEN-PHUOC TRAN PHARMD

Table of content: DR. BEATLE THIEN-PHUOC TRAN PHARMD (NPI 1821081910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821081910 NPI number — DR. BEATLE THIEN-PHUOC TRAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAN
Provider First Name:
BEATLE
Provider Middle Name:
THIEN-PHUOC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821081910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1029 JEFFERSON BLVD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
WEST SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95691-3344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-371-2022
Provider Business Mailing Address Fax Number:
916-371-2027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1029 JEFFERSON BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
WEST SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95691-3344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-371-2022
Provider Business Practice Location Address Fax Number:
916-371-2027
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH 50909 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 5527150001 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PHY 470830 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PHA 470830 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: RPH 50909 . This is a "PHARMACIST LICENSURE CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: PHY 47083 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 0550017 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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