Healthcare Provider Details

I. General information

NPI: 1518345958
Provider Name (Legal Business Name): CHRISTINE HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 COLUMBIA 100 PKWY SUITE B
COLUMBIA MD
21045-2336
US

IV. Provider business mailing address

8900 COLUMBIA 100 PKWY
COLUMBIA MD
21045-3676
US

V. Phone/Fax

Practice location:
  • Phone: 410-772-5453
  • Fax: 717-851-3565
Mailing address:
  • Phone: 410-772-5453
  • Fax: 717-851-3565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15892
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: