Healthcare Provider Details

I. General information

NPI: 1073239646
Provider Name (Legal Business Name): BRIAN C HOANG PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 107
SAN DIEGO CA
92121-3022
US

IV. Provider business mailing address

15311 VERMONT ST
WESTMINSTER CA
92683-6155
US

V. Phone/Fax

Practice location:
  • Phone: 858-457-4717
  • Fax:
Mailing address:
  • Phone: 714-718-2647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberPA62179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: