Provider Demographics
NPI:1053596361
Name:DANG PHARMACY GROUP INC
Entity type:Organization
Organization Name:DANG PHARMACY GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THI
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:626-960-8696
Mailing Address - Street 1:1250 S SUNSET AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3962
Mailing Address - Country:US
Mailing Address - Phone:626-960-8696
Mailing Address - Fax:626-960-8749
Practice Address - Street 1:1250 S SUNSET AVE STE 207
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3962
Practice Address - Country:US
Practice Address - Phone:626-960-8696
Practice Address - Fax:626-960-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
CAPHY489593336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121289OtherPK
CA1053596361Medicaid
CA1053596361Medicaid