Healthcare Provider Details

I. General information

NPI: 1386149862
Provider Name (Legal Business Name): NGUYEN HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 COTTAGE WAY, STE G2 #30038
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2321 DARWIN ST
HAYWARD CA
94545-3448
US

V. Phone/Fax

Practice location:
  • Phone: 805-215-5173
  • Fax:
Mailing address:
  • Phone: 805-215-5173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number14220191-2506
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: