Healthcare Provider Details

I. General information

NPI: 1720478357
Provider Name (Legal Business Name): DR. MINHCHAU HOANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 MUKILTEO SPEEDWAY
MUKILTEO WA
98275-4743
US

IV. Provider business mailing address

10200 MUKILTEO SPEEDWAY
MUKILTEO WA
98275-4743
US

V. Phone/Fax

Practice location:
  • Phone: 425-315-9213
  • Fax: 425-315-9553
Mailing address:
  • Phone: 425-315-9213
  • Fax: 425-315-9553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00040098
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: