=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598943391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH V. HOANG, DMD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2008
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6950 SANTA TERESA BLVD STE C
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95119-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-629-1212
-----------------------------------------------------
Fax | 408-629-1211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6950 SANTA TERESA BLVD STE C
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95119-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-629-1212
-----------------------------------------------------
Fax | 408-629-1211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KENNETH V HOANG
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 408-629-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 48913
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------