Healthcare Provider Details

I. General information

NPI: 1558825422
Provider Name (Legal Business Name): NICHOLAS HOANG OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 PARKMOOR AVE STE 208
SAN JOSE CA
95126-3407
US

IV. Provider business mailing address

911 BERN CT STE 140
SAN JOSE CA
95112-1242
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-0805
  • Fax:
Mailing address:
  • Phone: 408-573-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number23325
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: