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Licensing details for: A 206547

Name: Ta, Minhtri Nguyen Phuc

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: Tulane University School of Medicine

Graduation Year: 2023

Previous Names: Ta, Minhtri

Address of Record

4445 Magnolia Ave
RIVERSIDE CA 92501-4135
RIVERSIDE county
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Issuance Date

December 24, 2025

Expiration Date

February 29, 2028

Current Date / Time

April 3, 2026
5:40:50 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: Ta, Minhtri Nguyen Phuc

License/Registration Type: Postgraduate Training License

License Number: 12979 Primary Status: License Canceled

Address :
1000 W Carson St, Box 400
TORRANCE CA 90502-2004
LOS ANGELES COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

No AB 133 Survey Information Provided by Licensee

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