Healthcare Provider Details

I. General information

NPI: 1730102492
Provider Name (Legal Business Name): HUY DANG TUONG HOANG PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9397 HAVEN AVE
RANCHO CUCAMONGA CA
91730-5336
US

IV. Provider business mailing address

6042 MILTON CIR
HUNTINGTON BEACH CA
92647-2836
US

V. Phone/Fax

Practice location:
  • Phone: 866-393-8116
  • Fax: 866-393-5258
Mailing address:
  • Phone: 866-393-8116
  • Fax: 866-393-5258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number57604
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: