Provider Demographics
NPI:1336159870
Name:DO, TAN MINH
Entity Type:Individual
Prefix:
First Name:TAN
Middle Name:MINH
Last Name:DO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 CARUSO LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1034
Mailing Address - Country:US
Mailing Address - Phone:661-726-9342
Mailing Address - Fax:661-824-1802
Practice Address - Street 1:16912 STATE HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1226
Practice Address - Country:US
Practice Address - Phone:661-824-1800
Practice Address - Fax:661-824-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist