Healthcare Provider Details

I. General information

NPI: 1275334914
Provider Name (Legal Business Name): MIA DANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W RIDER ST
PERRIS CA
92571-3245
US

IV. Provider business mailing address

425 W RIDER ST
PERRIS CA
92571-3245
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-6303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: