MEDICARE: MYLOAN HOANG

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	163W00000X	Registered Nurse	RN95257845	CA
2	363LF0000X	Family Nurse Practitioner	95027018	CA

General Provider Information

NPI Number	:	1700568979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYLOAN HOANG

Provider Business Mailing Address
First Line	:	4035 S RIVERPOINT PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-0723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4035 S RIVERPOINT PKWY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-0723
Country	:	US
Telephone Number	:	844-937-8679
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	09/05/2023

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Directions to “ MYLOAN HOANG ” Practice Location

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