Healthcare Provider Details

I. General information

NPI: 1932362621
Provider Name (Legal Business Name): KHOA DANG HOANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 EXECUTIVE PARK CT
GERMANTOWN MD
20874-2643
US

IV. Provider business mailing address

9 EXECUTIVE PARK CT
GERMANTOWN MD
20874-2643
US

V. Phone/Fax

Practice location:
  • Phone: 240-668-4150
  • Fax: 240-442-1138
Mailing address:
  • Phone: 240-668-4150
  • Fax: 240-442-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0069292
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberD0069292
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: