Healthcare Provider Details

I. General information

NPI: 1437458239
Provider Name (Legal Business Name): BRIAN HOANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 04/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WEST THUNDERBIRD ROAD STE. E-456
GLENDALE AZ
85306
US

IV. Provider business mailing address

5757 WEST THUNDERBIRD ROAD STE. E-456
GLENDALE AZ
85306
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-4570
  • Fax: 602-865-4575
Mailing address:
  • Phone: 602-865-4570
  • Fax: 602-865-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberR73891
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number56208
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: