Healthcare Provider Details

I. General information

NPI: 1972789717
Provider Name (Legal Business Name): ALYSSA THIEN-THU HOANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 02/04/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 4TH ST STE 150
RANCHO CUCAMONGA CA
91730-0979
US

IV. Provider business mailing address

10750 4TH ST STE 150
RANCHO CUCAMONGA CA
91730-0979
US

V. Phone/Fax

Practice location:
  • Phone: 909-476-4444
  • Fax:
Mailing address:
  • Phone: 909-476-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC168263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81022
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: