Provider Demographics
NPI:1619217288
Name:THAN, NHAT TAN HOANG (DO)
Entity Type:Individual
Prefix:DR
First Name:NHAT TAN
Middle Name:HOANG
Last Name:THAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TAN
Other - Middle Name:HOANG
Other - Last Name:THAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:400 N PEPPER AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1801
Mailing Address - Country:US
Mailing Address - Phone:909-580-1862
Mailing Address - Fax:909-580-1388
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:909-580-1862
Practice Address - Fax:909-580-1388
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13584207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine