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General NPI Number Information
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NPI Number | 1235801333
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Entity Type | Organization
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Legal Business Name | HOA BANH, DMD, INC
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Dates
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Enumeration Date | 09/28/2021
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 420 E KETTLEMAN LN STE 6
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City | LODI
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State | CA
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Zip | 95240-5957
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Country | US
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Telephone | 209-368-6788
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Fax | 888-348-9455
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Provider Business Mailing Address
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Address Line | 420 E KETTLEMAN LN STE 6
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City | LODI
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State | CA
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Zip | 95240-5957
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Country | US
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Telephone | 209-368-6788
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Fax | 888-348-9455
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Authorized Official
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Title or Position | DENTIST
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Name | DR. HOA HUNG BANH
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Credential | DMD
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Telephone | 209-368-6788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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