Healthcare Provider Details

I. General information

NPI: 1740939628
Provider Name (Legal Business Name): PETER HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 835
ORANGE CA
92868-3213
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2300
  • Fax:
Mailing address:
  • Phone: 714-480-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA190873
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036.174382
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: