Healthcare Provider Details

I. General information

NPI: 1285123323
Provider Name (Legal Business Name): STEVEN HOANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 SPRING ST
FRIDAY HARBOR WA
98250-9782
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-8004
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-2141
  • Fax: 360-378-1785
Mailing address:
  • Phone: 360-729-1412
  • Fax: 360-729-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP61115874
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: