Healthcare Provider Details

I. General information

NPI: 1295736858
Provider Name (Legal Business Name): TRAM QUYNH HOANG D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 04/14/2006

III. Provider practice location address

2176 THE ALAMEDA
SAN JOSE CA
95126-1144
US

IV. Provider business mailing address

2176 THE ALAMEDA
SAN JOSE CA
95126-1144
US

V. Phone/Fax

Practice location:
  • Phone: 408-564-6805
  • Fax: 408-816-8767
Mailing address:
  • Phone: 408-564-6805
  • Fax: 408-816-8767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number44697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: