Healthcare Provider Details

I. General information

NPI: 1477628642
Provider Name (Legal Business Name): KENNETH VU HOANG D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 SANTA TERESA BLVD STE C
SAN JOSE CA
95119-1300
US

IV. Provider business mailing address

6950 SANTA TERESA BLVD STE C
SAN JOSE CA
95119-1300
US

V. Phone/Fax

Practice location:
  • Phone: 408-629-1212
  • Fax: 408-629-1211
Mailing address:
  • Phone: 408-629-1212
  • Fax: 408-629-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number48913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: