MEDICARE: DR. TUNG THANH HOANG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D012802	AZ

General Provider Information

NPI Number	:	1215869128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUNG THANH HOANG DDS

Provider Business Mailing Address
First Line	:	4824 LA MADERA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91732-1614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7890 E FLORENTINE RD
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-1204
Country	:	US
Telephone Number	:	928-772-9860
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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