Healthcare Provider Details

I. General information

NPI: 1063643419
Provider Name (Legal Business Name): HWA SOO HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax: 415-476-7747
Mailing address:
  • Phone: 415-476-7000
  • Fax: 415-476-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC170555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: