Healthcare Provider Details

I. General information

NPI: 1316982754
Provider Name (Legal Business Name): LIEN NGOC HOANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 N PECOS RD
HENDERSON NV
89074-1918
US

IV. Provider business mailing address

PO BOX 98978
LAS VEGAS NV
89193-8978
US

V. Phone/Fax

Practice location:
  • Phone: 702-430-3570
  • Fax: 702-430-3571
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-671-6883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12465
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: