Healthcare Provider Details

I. General information

NPI: 1366445413
Provider Name (Legal Business Name): THUY THU HOANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/20/2006

III. Provider practice location address

2593 S KING RD STE 7
SAN JOSE CA
95122-1880
US

IV. Provider business mailing address

2593 S KING RD STE 7
SAN JOSE CA
95122-1880
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-7390
  • Fax: 408-238-7395
Mailing address:
  • Phone: 408-238-7390
  • Fax: 408-238-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG077533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: