Healthcare Provider Details

I. General information

NPI: 1114212081
Provider Name (Legal Business Name): SOOK C HOANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOOK CHAN HOANG MD

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST
CHARLOTTESVILLE VA
22908-4923
US

IV. Provider business mailing address

26 GROTTO AVE APARTMENT 2L
PROVIDENCE RI
02906-5557
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-3090
  • Fax: 434-244-9445
Mailing address:
  • Phone: 267-304-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number249232
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberLP03660
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101262765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: