Healthcare Provider Details

I. General information

NPI: 1649915307
Provider Name (Legal Business Name): TIEN HOANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 ORCAS PL NE
RENTON WA
98059-6316
US

IV. Provider business mailing address

418 ORCAS PL NE
RENTON WA
98059-6316
US

V. Phone/Fax

Practice location:
  • Phone: 228-437-5263
  • Fax:
Mailing address:
  • Phone: 228-437-5263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4389-23
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6001294-15
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61305709
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11812
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: