Healthcare Provider Details

I. General information

NPI: 1740515725
Provider Name (Legal Business Name): DAN TAN HOANG RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

345 N SANTA MARIA ST
ANAHEIM CA
92801-6158
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4490
  • Fax:
Mailing address:
  • Phone: 408-966-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number60572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: