Healthcare Provider Details

I. General information

NPI: 1154810943
Provider Name (Legal Business Name): DIEM CHAU HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/11/2021
Certification Date: 07/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7170 DAY CREEK BLVD
RANCHO CUCAMONGA CA
91739-8821
US

IV. Provider business mailing address

6811 LANDRIANO PL
RANCHO CUCAMONGA CA
91701-8598
US

V. Phone/Fax

Practice location:
  • Phone: 909-463-7843
  • Fax:
Mailing address:
  • Phone: 818-564-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: