Provider Demographics
NPI:1386922458
Name:TAO, HOANG (RPH)
Entity type:Individual
Prefix:
First Name:HOANG
Middle Name:
Last Name:TAO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10621 CARMENITA RD
Mailing Address - Street 2:T-0227
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-4017
Mailing Address - Country:US
Mailing Address - Phone:562-298-0044
Mailing Address - Fax:562-298-0044
Practice Address - Street 1:10621 CARMENITA RD
Practice Address - Street 2:T-0227
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4017
Practice Address - Country:US
Practice Address - Phone:562-298-0044
Practice Address - Fax:562-298-0044
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2011-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist