Healthcare Provider Details

I. General information

NPI: 1285122580
Provider Name (Legal Business Name): MELISSA HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-938-2113
  • Fax: 408-579-6143
Mailing address:
  • Phone: 408-938-2113
  • Fax: 408-579-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: