Healthcare Provider Details

I. General information

NPI: 1669273652
Provider Name (Legal Business Name): ANDREW GIA-BAO HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FIVAY RD
HUDSON FL
34667-7103
US

IV. Provider business mailing address

201 CANAL ST APT G
METAIRIE LA
70005-3600
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-2929
  • Fax: 727-819-2928
Mailing address:
  • Phone: 985-870-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: