Healthcare Provider Details

I. General information

NPI: 1902463094
Provider Name (Legal Business Name): DALE TIMOTHY HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 SILVER AVE FL 2
SAN FRANCISCO CA
94134-1229
US

IV. Provider business mailing address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

V. Phone/Fax

Practice location:
  • Phone: 628-754-8100
  • Fax:
Mailing address:
  • Phone: 607-280-7430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA176210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: