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Licensing details for: PTL 12979

Name: Ta, Minhtri Nguyen Phuc

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: Tulane University School of Medicine

Graduation Year: 2023

Previous Names: Ta, Minhtri

Current Enrolled Postgraduate Training Program

Facility Name: LOS ANGELES COUNTY-HARBOR-UCLA MEDICAL CENTER PROGRAM

City: Torrance

State: California

Speciality: Internal medicine

Start Date: 06/24/2023

Anticipated End Date: 09/23/2024

Address of Record

1000 W Carson St, Box 400
TORRANCE CA 90502-2004
LOS ANGELES county
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Issuance Date

November 21, 2023

Expiration Date

N/A

Current Date / Time

April 3, 2026
4:13:20 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: Ta, Minhtri Nguyen Phuc

License/Registration Type: Physician's and Surgeon's

License Number: 206547 Primary Status: License Renewed & Current

Address :
4445 Magnolia Ave
RIVERSIDE CA 92501-4135
RIVERSIDE COUNTY

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