Healthcare Provider Details

I. General information

NPI: 1073076808
Provider Name (Legal Business Name): MARTIN MINH HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4234 RIVERWALK PKWY STE 230
RIVERSIDE CA
92505-3312
US

IV. Provider business mailing address

4234 RIVERWALK PKWY STE 230
RIVERSIDE CA
92505-3312
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-3672
  • Fax: 951-781-0365
Mailing address:
  • Phone: 951-781-3672
  • Fax: 951-781-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA193359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: