Healthcare Provider Details

I. General information

NPI: 1952959199
Provider Name (Legal Business Name): LAN HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MALIN RD
BROOMALL PA
19008-1429
US

IV. Provider business mailing address

50 N MALIN RD
BROOMALL PA
19008-1429
US

V. Phone/Fax

Practice location:
  • Phone: 610-356-0800
  • Fax:
Mailing address:
  • Phone: 610-356-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOC11798
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: