Healthcare Provider Details

I. General information

NPI: 1831209303
Provider Name (Legal Business Name): NAM NGOC HOANG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: OETER NGOC HOANG DMD

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 RESEDA BLVD STE 104
NORTHRIDGE CA
91324-3932
US

IV. Provider business mailing address

9029 RESEDA BLVD STE 104
NORTHRIDGE CA
91324-3932
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-9700
  • Fax: 818-337-3044
Mailing address:
  • Phone: 818-701-9700
  • Fax: 818-337-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: