Healthcare Provider Details

I. General information

NPI: 1841527942
Provider Name (Legal Business Name): TIM PATRICK HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E WASHINGTON ST
COLTON CA
92324-4621
US

IV. Provider business mailing address

1850 E. WASHINGTON STREET
COLTON CA
92324-4621
US

V. Phone/Fax

Practice location:
  • Phone: 909-887-2991
  • Fax: 909-887-5694
Mailing address:
  • Phone: 909-887-2991
  • Fax: 909-887-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: