Healthcare Provider Details

I. General information

NPI: 1427875178
Provider Name (Legal Business Name): HOANG VAN DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 N MEADOWLARK WAY STE C&D
COEUR D ALENE ID
83815-5041
US

IV. Provider business mailing address

2946 W THORNDALE LOOP
COEUR D ALENE ID
83815-8529
US

V. Phone/Fax

Practice location:
  • Phone: 208-618-2593
  • Fax:
Mailing address:
  • Phone: 541-891-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: