1487640488 NPI NUMBER - DONG TAM CORPORATION
Summary
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NPI Number |
1487640488 |
| Entity Type Code |
Organization |
| Provider Legal Name |
DONG TAM CORPORATION |
| Provider Business Practice Location Address |
9200 E VALLEY BLVD
ROSEMEAD, CA
ZIP 91770
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| Practice Location Phone Number |
(626) 573-9477 |
| Provider Taxonomy Code |
332BX2000X - Durable Medical Equipment & Medical Supplies |
| Specialization |
Oxygen Equipment & Supplies |
| Provider Enumeration Date |
9/25/2005 |
| Last Update Date |
7/1/2008 |
NPI Number 1487640488 is assigned to an organization registered under the healthcare provider name DONG TAM CORPORATION .
The provider is doing business as ROSA PHARMACY .
The provider is physically located at:
9200 E VALLEY BLVD
ROSEMEAD, CA
ZIP 91770-900
Phone: (626) 573-9477
The provider's authorized official is LINH NGHI PHAM .
The authorized official title is MANAGER and has the following contact phone number (626) 573-9477 .
The enumeration date for this NPI number is 9/25/2005 and was last updated on 7/1/2008 .
Map - Location of Practice
Taxonomy Codes
The following information regarding the scope of practice of this provider is available:
| 1 |
332BX2000X |
Durable Medical Equipment & Medical Supplies |
Oxygen Equipment & Supplies |
PHY41508 |
CA |
View Code |
| 2 |
3336C0003X |
Pharmacy |
Community/Retail Pharmacy |
PHY41508 |
CA |
View Code |
Other (Legacy) Identifiers
The following legacy identifiers for this provider are available:
| 1 |
1273920001 |
MEDICARE NSC |
CA |
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| 2 |
0535952 |
OTHER |
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NABP |
| 3 |
PHA415080 |
MEDICAID |
CA |
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NPI Record
| 1 |
NPI |
1487640488 |
| 2 |
Entity Type Code |
2 |
| 3 |
Employer Identification Number EIN |
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| 4 |
Provider Organization Name Legal Business Name |
DONG TAM CORPORATION |
| 5 |
Provider Other Organization Name |
ROSA PHARMACY |
| 6 |
Provider Other Organization Name Type Code |
3 |
| 7 |
Provider First Line Business Practice Location Address |
9200 E VALLEY BLVD |
| 8 |
Provider Business Practice Location Address City Name |
ROSEMEAD |
| 9 |
Provider Business Practice Location Address State Name |
CA |
| 10 |
Provider Business Practice Location Address Postal Code |
917701900 |
| 11 |
Provider Business Practice Location Address Country Code If outside U S |
US |
| 12 |
Provider Business Practice Location Address Telephone Number |
6265739477 |
| 13 |
Provider Enumeration Date |
9/25/2005 |
| 14 |
Last Update Date |
7/1/2008 |
| 15 |
Authorized Official Last Name |
PHAM |
| 16 |
Authorized Official First Name |
LINH |
| 17 |
Authorized Official Middle Name |
NGHI |
| 18 |
Authorized Official Title or Position |
MANAGER |
| 19 |
Authorized Official Telephone Number |
6265739477 |
| 20 |
Healthcare Provider Taxonomy Code 1 |
332BX2000X |
| 21 |
Provider License Number 1 |
PHY41508 |
| 22 |
Provider License Number State Code 1 |
CA |
| 23 |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
| 24 |
Healthcare Provider Taxonomy Code 2 |
3336C0003X |
| 25 |
Provider License Number 2 |
PHY41508 |
| 26 |
Provider License Number State Code 2 |
CA |
| 27 |
Healthcare Provider Primary Taxonomy Switch 2 |
Y |
| 28 |
Other Provider Identifier 1 |
1273920001 |
| 29 |
Other Provider Identifier Type Code 1 |
07 |
| 30 |
Other Provider Identifier State 1 |
CA |
| 31 |
Other Provider Identifier 2 |
0535952 |
| 32 |
Other Provider Identifier Type Code 2 |
01 |
| 33 |
Other Provider Identifier Issuer 2 |
NABP |
| 34 |
Other Provider Identifier 3 |
PHA415080 |
| 35 |
Other Provider Identifier Type Code 3 |
05 |
| 36 |
Other Provider Identifier State 3 |
CA |
| 37 |
Is Organization Subpart |
N |
| 38 |
Authorized Official Name Prefix Text |
MISS |
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This page was last updated on: 5/14/2013
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.