Healthcare Provider Details

I. General information

NPI: 1437718582
Provider Name (Legal Business Name): HUY QUANG HOANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 MEDICAL CENTER DR STE 300
ORANGE CITY FL
32763-8227
US

IV. Provider business mailing address

PO BOX 935921
ATLANTA GA
31193-5921
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME168045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: