Healthcare Provider Details

I. General information

NPI: 1689747222
Provider Name (Legal Business Name): JACQUELINE K. HOANG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 BACKLICK RD
SPRINGFIELD VA
22151-3904
US

IV. Provider business mailing address

5502 BACKLICK RD
SPRINGFIELD VA
22151-3904
US

V. Phone/Fax

Practice location:
  • Phone: 703-642-8306
  • Fax: 703-642-8342
Mailing address:
  • Phone: 703-642-8306
  • Fax: 703-642-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101053611
License Number StateVA

VIII. Authorized Official

Name: DR. JACQUELINE KIM HOANG
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 703-642-8306