Healthcare Provider Details

I. General information

NPI: 1356718571
Provider Name (Legal Business Name): KIM HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9372 RICHMOND HWY
LORTON VA
22079-1827
US

IV. Provider business mailing address

9372 RICHMOND HWY
LORTON VA
22079-1827
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-0103
  • Fax: 571-642-0381
Mailing address:
  • Phone: 571-642-0103
  • Fax: 571-642-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202214348
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: