Healthcare Provider Details

I. General information

NPI: 1164486296
Provider Name (Legal Business Name): RICHARD THAO HOANG P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 500
WHITTIER CA
90602
US

IV. Provider business mailing address

12462 PUTNAM ST STE 500
WHITTIER CA
90602-1049
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5444
  • Fax: 562-789-4449
Mailing address:
  • Phone: 562-789-5444
  • Fax: 562-789-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA16711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: