Healthcare Provider Details

I. General information

NPI: 1881480929
Provider Name (Legal Business Name): SAM VIET HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2677 CLAYTON RD
CONCORD CA
94519-2799
US

IV. Provider business mailing address

823 SAINT KITTS CT
SAN JOSE CA
95127-1035
US

V. Phone/Fax

Practice location:
  • Phone: 925-689-2398
  • Fax:
Mailing address:
  • Phone: 669-273-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: