Provider Demographics
NPI:1316259021
Name:DINH, MINHPHUONG
Entity type:Individual
Prefix:
First Name:MINHPHUONG
Middle Name:
Last Name:DINH
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 1:211 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3831
Mailing Address - Country:US
Mailing Address - Phone:949-646-4960
Mailing Address - Fax:949-646-0201
Practice Address - Street 1:211 E 17TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3831
Practice Address - Country:US
Practice Address - Phone:949-646-4960
Practice Address - Fax:949-646-0201
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist