Healthcare Provider Details

I. General information

NPI: 1740110535
Provider Name (Legal Business Name): GIA-LIEM NICHOLAS HOANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 COPPER MILL BLVD
ZACHARY LA
70791-7393
US

IV. Provider business mailing address

4751 CHARLMARK DR
NEW ORLEANS LA
70127-3503
US

V. Phone/Fax

Practice location:
  • Phone: 225-286-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7790
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: