Healthcare Provider Details

I. General information

NPI: 1003663279
Provider Name (Legal Business Name): KIM NGOC HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2024
Last Update Date: 05/04/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S 76TH ST
OMAHA NE
68114-4519
US

IV. Provider business mailing address

909 S 76TH ST
OMAHA NE
68114-4519
US

V. Phone/Fax

Practice location:
  • Phone: 402-390-2100
  • Fax:
Mailing address:
  • Phone: 404-390-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: