Healthcare Provider Details

I. General information

NPI: 1003166190
Provider Name (Legal Business Name): THINH DINH HOANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2012
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 MARTIN LUTHER KING JR BLVD STE # 1
LYNWOOD CA
90262-9026
US

IV. Provider business mailing address

3625 MARTIN LUTHER KING JR BLVD STE 1
LYNWOOD CA
90262-3509
US

V. Phone/Fax

Practice location:
  • Phone: 424-406-2066
  • Fax:
Mailing address:
  • Phone: 424-406-2066
  • Fax: 424-406-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: