Healthcare Provider Details

I. General information

NPI: 1194279604
Provider Name (Legal Business Name): T & G HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2016
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3948 PECK RD STE. A1
EL MONTE CA
91732-2255
US

IV. Provider business mailing address

24031 MARGUERITE PKWY STE A
MISSION VIEJO CA
92692-1929
US

V. Phone/Fax

Practice location:
  • Phone: 626-448-2507
  • Fax: 626-448-2576
Mailing address:
  • Phone: 949-586-1700
  • Fax: 949-586-4683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY 54479
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY 54479
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHY 54479
License Number StateCA

VIII. Authorized Official

Name: DR. KHANH-LONG THAI
Title or Position: CEO
Credential: PHARM.D.
Phone: 949-586-1700