Healthcare Provider Details

I. General information

NPI: 1760448302
Provider Name (Legal Business Name): TUAN ANTHONY HOANG-XUAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 102
CHINO CA
91710-1401
US

IV. Provider business mailing address

13768 ROSWELL AVE SUITE 102
CHINO CA
91710-1401
US

V. Phone/Fax

Practice location:
  • Phone: 909-364-1959
  • Fax: 909-752-4171
Mailing address:
  • Phone: 909-364-1959
  • Fax: 909-752-4171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number20A7954
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number20A7954
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number20A7954
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number20A7954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: