Provider Demographics
NPI:1750480158
Name:TON, HOANG TICH (MD)
Entity Type:Individual
Prefix:DR
First Name:HOANG
Middle Name:TICH
Last Name:TON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17559 MONDINO DR
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4160
Mailing Address - Country:US
Mailing Address - Phone:213-620-1720
Mailing Address - Fax:213-620-8753
Practice Address - Street 1:642 N BROADWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2838
Practice Address - Country:US
Practice Address - Phone:213-620-1720
Practice Address - Fax:213-620-8753
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392370Medicaid
CA00A392370Medicaid
CAC35504Medicare UPIN