Healthcare Provider Details

I. General information

NPI: 1083343362
Provider Name (Legal Business Name): DUSTIN HOANG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 12TH ST
OKLAHOMA CITY OK
73106-6802
US

IV. Provider business mailing address

440 MERCHANT DR
NORMAN OK
73069-6470
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-5800
  • Fax:
Mailing address:
  • Phone: 405-809-8713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6204
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: