Provider Demographics
NPI:1215507918
Name:TRAN, ARIELLE KHOINGUYEN
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:KHOINGUYEN
Last Name:TRAN
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 1:11301 EUCLID ST SPC 137
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-1438
Mailing Address - Country:US
Mailing Address - Phone:714-548-5255
Mailing Address - Fax:
Practice Address - Street 1:13129 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1079
Practice Address - Country:US
Practice Address - Phone:714-530-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-26
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist