Healthcare Provider Details

I. General information

NPI: 1700935814
Provider Name (Legal Business Name): THIEUHA TUAN HOANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HARBOR BLVD SUITE 600
ANAHEIM CA
92805-3733
US

IV. Provider business mailing address

PO BOX 128 E-47 MEDICAL
SAN CLEMENTE CA
92674-0128
US

V. Phone/Fax

Practice location:
  • Phone: 714-978-7488
  • Fax:
Mailing address:
  • Phone: 714-978-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA97879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: