Healthcare Provider Details

I. General information

NPI: 1700416674
Provider Name (Legal Business Name): ANGELLINE TU ANH DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 11/27/2023
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9191 WESTMINSTER AVE
GARDEN GROVE CA
92844-2751
US

IV. Provider business mailing address

2626 W DAHL LN
SANTA ANA CA
92704-3110
US

V. Phone/Fax

Practice location:
  • Phone: 714-899-1111
  • Fax: 714-899-2808
Mailing address:
  • Phone: 714-200-8698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number80839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: