Healthcare Provider Details

I. General information

NPI: 1194937748
Provider Name (Legal Business Name): DAREN T HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 N EUCALYPTUS AVE
RIALTO CA
92376
US

IV. Provider business mailing address

106 N EUCALYPTUS AVE
RIALTO CA
92376
US

V. Phone/Fax

Practice location:
  • Phone: 909-875-1299
  • Fax: 909-875-0101
Mailing address:
  • Phone: 909-875-1299
  • Fax: 909-875-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberCA44698
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: