Healthcare Provider Details

I. General information

NPI: 1366947202
Provider Name (Legal Business Name): KEVIN HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

IV. Provider business mailing address

1822 SAN MIGUEL DR
WALNUT CREEK CA
94596-8606
US

V. Phone/Fax

Practice location:
  • Phone: 924-945-3580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number165510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: