Healthcare Provider Details

I. General information

NPI: 1477951028
Provider Name (Legal Business Name): KIM HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2014
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD BLDG 40
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

7925 WINCHESTER BLVD BLDG 40
QUEENS VILLAGE NY
11427-2128
US

V. Phone/Fax

Practice location:
  • Phone: 909-728-7271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number290845
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA161022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: