Healthcare Provider Details

I. General information

NPI: 1760473003
Provider Name (Legal Business Name): KIM DUC HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1892
US

IV. Provider business mailing address

2800 E COYOTE MINT CIR
PAYSON AZ
85541-2921
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-931-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21690
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: