Healthcare Provider Details

I. General information

NPI: 1649722364
Provider Name (Legal Business Name): DUNG THI THAO HOANG PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 NE 61ST AVE
PORTLAND OR
97213-4249
US

IV. Provider business mailing address

1525 NE 61ST AVE
PORTLAND OR
97213-4249
US

V. Phone/Fax

Practice location:
  • Phone: 818-405-6526
  • Fax:
Mailing address:
  • Phone: 818-405-6526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH0015598
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: