Healthcare Provider Details

I. General information

NPI: 1710317441
Provider Name (Legal Business Name): VIVIAN HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 IOOF AVE
GILROY CA
95020-5204
US

IV. Provider business mailing address

PO BOX 21121
SAN JOSE CA
95151-1121
US

V. Phone/Fax

Practice location:
  • Phone: 408-846-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number806542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: