Healthcare Provider Details

I. General information

NPI: 1467077933
Provider Name (Legal Business Name): KIET A.T. TON, MD, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14024 MAGNOLIA ST STE 104
WESTMINSTER CA
92683-4766
US

IV. Provider business mailing address

14024 MAGNOLIA ST STE 104
WESTMINSTER CA
92683-4766
US

V. Phone/Fax

Practice location:
  • Phone: 714-895-8583
  • Fax: 714-895-8625
Mailing address:
  • Phone: 714-895-8583
  • Fax: 714-895-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KIET ANH THAT TON
Title or Position: PRESIDENT
Credential: MD
Phone: 657-789-0999