Provider Demographics
NPI:1881449403
Name:MA, JUSTIN KHOA DANG (PHARMD, BCIDP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KHOA DANG
Last Name:MA
Suffix:
Gender:M
Credentials:PHARMD, BCIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 HILLMAN ST APT 139
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-8063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2311 HILLMAN ST APT 139
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-8063
Practice Address - Country:US
Practice Address - Phone:714-725-6584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA872261835I0206X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835I0206XPharmacy Service ProvidersPharmacistInfectious Diseases