Healthcare Provider Details

I. General information

NPI: 1952428161
Provider Name (Legal Business Name): MINH TAT HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 MIRA MESA BLVD BLDG C SUITE E
SAN DIEGO CA
92121-4304
US

IV. Provider business mailing address

14633 RIO RANCHO
SAN DIEGO CA
92127-3638
US

V. Phone/Fax

Practice location:
  • Phone: 858-558-2121
  • Fax:
Mailing address:
  • Phone: 619-847-3677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number52729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: