Healthcare Provider Details

I. General information

NPI: 1821170374
Provider Name (Legal Business Name): SCOTT ANH HOANG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 ESTUDILLO AVE STE 204
SAN LEANDRO CA
94577-4915
US

IV. Provider business mailing address

433 ESTUDILLO AVE STE 204
SAN LEANDRO CA
94577-4915
US

V. Phone/Fax

Practice location:
  • Phone: 510-895-1977
  • Fax: 510-895-2297
Mailing address:
  • Phone: 510-895-1977
  • Fax: 510-895-2297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: