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General NPI Number Information
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NPI Number | 1861694424
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Entity Type | Individual
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Provider Name | LONG NGOC HOANG D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 1315 S ADAMS ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4404
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Country | US
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Telephone | 833-484-6359
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2233
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City | WOODSTOCK
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State | GA
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Zip | 30188-1376
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Country | US
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Telephone | 817-781-7237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 87500
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | P5079
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 32276
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P5079
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License Number State | TX
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