Active NPI
Jefferson Anh Duy Dang, PHARMD
- Pharmacist
- Colton, CA
National Provider Identifier
1477158772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 83753
- Practice address
- 1010 N Pepper Ave
Colton, CA 92324-1806 - Phone
- (909) 954-2242
- NPI assigned
- Dec 3, 2020
- Last updated
- Dec 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 83753 | CA | Primary |
Addresses
Primary practice location
1010 N Pepper Ave
Colton, CA 92324-1806
Mailing address
25965 Brentwood Ave
Loma Linda, CA 92354-3967
Phone (626) 297-9562
Other practice location 1
14426 Palmdale Rd
Victorville, CA 92392-2743
Phone (760) 243-1771
Other practice location 2
211 W Base Line Rd
Rialto, CA 92376-3305
Phone (909) 874-8002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 83753 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Garfield Beach CVS LLC | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients | |
| Garfield Beach CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606953600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606953600000",
"number": "1477158772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25965 BRENTWOOD AVE",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923543967",
"telephone_number": "626-297-9562"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 N PEPPER AVE",
"city": "COLTON",
"state": "CA",
"postal_code": "923241806",
"telephone_number": "909-954-2242"
}
],
"practiceLocations": [
{
"address_1": "14426 Palmdale Rd",
"address_purpose": "LOCATION",
"city": "Victorville",
"state": "CA",
"postal_code": "923922743",
"country_code": "US",
"telephone_number": "760-243-1771",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "211 W Base Line Rd",
"address_purpose": "LOCATION",
"city": "Rialto",
"state": "CA",
"postal_code": "923763305",
"country_code": "US",
"telephone_number": "909-874-8002",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DANG",
"first_name": "JEFFERSON",
"middle_name": "ANH DUY",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-12-03",
"last_updated": "2020-12-03",
"certification_date": "2020-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "83753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.