Healthcare Provider Details

I. General information

NPI: 1720895345
Provider Name (Legal Business Name): ANGELINE QUYNH-NHI HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MYRTLE ST
BELMONT NC
28012-5200
US

IV. Provider business mailing address

19220 CARSEN GRACE CT APT 101
CHARLOTTE NC
28273-5064
US

V. Phone/Fax

Practice location:
  • Phone: 704-954-8959
  • Fax:
Mailing address:
  • Phone: 714-673-5030
  • 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: