Provider Demographics
NPI:1750574075
Name:PACIFIC COAST DERMATOLOGY, INC.
Entity type:Organization
Organization Name:PACIFIC COAST DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HOANG-XUAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-364-1959
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-364-1959
Mailing Address - Fax:909-752-4171
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-364-1959
Practice Address - Fax:909-752-4171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7954207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty