Provider Demographics
NPI:1477993350
Name:TA, KHOA DANG (DC)
Entity Type:Individual
Prefix:
First Name:KHOA
Middle Name:DANG
Last Name:TA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 VALLEY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1919
Mailing Address - Country:US
Mailing Address - Phone:626-415-6213
Mailing Address - Fax:626-773-8996
Practice Address - Street 1:9105 VALLEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1919
Practice Address - Country:US
Practice Address - Phone:626-415-6213
Practice Address - Fax:626-773-8996
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477993350OtherNATIONAL PROVIDER ID