Healthcare Provider Details

I. General information

NPI: 1205304508
Provider Name (Legal Business Name): HOANG AND NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 SOUTHLAND DR STE 100
HAYWARD CA
94545-1558
US

IV. Provider business mailing address

777 SOUTHLAND DR STE 100
HAYWARD CA
94545-1558
US

V. Phone/Fax

Practice location:
  • Phone: 415-504-2629
  • Fax:
Mailing address:
  • Phone: 510-361-0300
  • Fax: 510-361-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. EMERALD NGUYEN
Title or Position: ORTHODONTIST/PARTNER
Credential: DDS, MS
Phone: 510-361-0300