Individual
RICKY PHONG TAN MAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1868 PACIFIC AVE, LONG BEACH, CA 90806-6113
(562) 595-4718
Mailing address
PO BOX 9576, ANAHEIM, CA 92812-7576
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
A68178
CA
Other
Enumeration date
07/17/2006
Last updated
05/22/2012
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